Clinical Intelligence Platform

Your prior auth and appeals process, finally automated.

Not routed to a queue. Executed.

When a claim gets denied, your staff spends hours hunting through charts, faxes, and outside records to build the appeal. Almvia reads the denial reason, pulls the clinical evidence from your EHR, matches it against the payer's medical policy, and drafts a cited appeal packet — before anyone opens their inbox.

Join the Pilot Program See how it works

The problem

The industry routes denied claims to humans. Almvia executes the response.

When a physician orders a procedure, someone on your team has to get insurance approval first. They open the EHR, sort through notes and outside records, figure out what the payer actually requires, and package it all up — for every single request. Thirteen hours a week, per physician, on average.

Then the insurer says no. The appeal requires the same hunt all over again. Most practices either write a generic response that rarely wins, or they write off the denied revenue entirely because chasing it takes too long.

Current tools make the queue more organized. They assign the denied claim to a staff member with a flag and a due date. The staff member still does all the clinical work.

Almvia does the clinical work. It reads the specific denial reason, retrieves the relevant evidence from your EHR through a direct FHIR API connection, cross-references the payer's published medical necessity criteria, and generates a fully cited appeal narrative. Your staff reviews, approves, and submits. The hunting is already done.

How it works

Four steps.
Fully automated.

From denial to appeal-ready packet, without your staff touching the chart.

Denial detected

Almvia reads the incoming denial code and identifies the specific medical necessity criterion the payer applied. Under the CMS prior authorization final rule effective 2027, payers must now give specific denial reasons, not vague rejections. That specificity is the input Almvia acts on.

Chart retrieved

Almvia connects to your EHR via FHIR R4 and pulls the patient's clinical record — diagnoses, medications, lab results, prior encounters, and treatment history. It simultaneously ingests unstructured sources: faxed specialist consult notes, scanned outside imaging reports, and prior correspondence that the EHR doesn't capture.

Policy matched

The retrieved evidence is cross-referenced against the payer's published medical necessity policy for the specific procedure. Almvia identifies what supports the case, flags what's missing, and cites every finding with source, date, and page number.

Appeal drafted

A fully cited appeal narrative lands in your admin team's inbox, ready to review. They verify, edit if needed, and approve. Nothing is ever submitted without explicit sign-off. Every action is logged with the reviewer's name and timestamp.

Prior authorization

Built before the denial arrives.

Most denials are preventable at submission. Almvia monitors your EHR for new cases in real time. When a procedure is ordered that requires prior authorization, it detects it automatically, pulls the supporting clinical evidence, checks it against the payer's criteria, and flags anything missing before the packet goes out.

What Almvia builds for every prior auth request

A one-page clinical summary tying the diagnosis to the procedure and the payer's medical necessity criteria.
An evidence list with citations — every supporting note, lab result, imaging report, and treatment history entry, each linked to its source and date.
A missing items checklist identifying what the payer will likely ask for that isn't yet in the record, before the packet is submitted.
A portal-ready bundle assembled and formatted for submission.

The goal is to get it right the first time. Every prior auth that avoids a denial is hours of rework your team doesn't have to do.

Denials and appeals

When the denial arrives, the work is already done.

A denial letter used to be the beginning of a long manual process. Almvia makes it the beginning of an automated one.

When a denial arrives — by fax, PDF, or remit file — Almvia catches it immediately. It reads the specific denial reason now required under federal rules, links it to the patient and claim, and identifies the exact clinical criterion the payer said wasn't met.

From there it retrieves the evidence in the chart that addresses that criterion directly. Not a general summary of the patient's history. The specific documentation that responds to the specific denial reason — with citations to source, date, page, and author.

It then drafts the appeal narrative. The letter addresses the payer's stated criterion point by point, cites the supporting clinical evidence, and structures the argument in the format the payer's appeal process requires.

Your staff receives a review-ready packet. They read it, edit anything they want to change, and approve it. Nothing leaves the system without their sign-off. The full audit log records who reviewed it, what version was approved, and when it was submitted.

Almvia tracks every appeal through final resolution. Every outcome is logged — approved, denied at first level, escalated, overturned on external review. That data improves every future submission.

Built on what the regulations now require

CMS now requires payers to give specific denial reasons and respond to prior auth requests via FHIR API. Almvia is the provider-side system built to act on both.

CMS-0057-F · 21st Century Cures Act · FHIR R4 Native

The CMS Interoperability and Prior Authorization Final Rule, finalized January 2024, requires affected payers to implement FHIR R4 APIs for prior authorization by January 2027 and to provide a specific reason for every denial. The 21st Century Cures Act prohibits EHR information blocking and requires clinical data access through certified FHIR APIs — the legal foundation for Almvia's EHR integration. CAQH estimates that full electronic adoption of prior authorization could save the industry $515 million annually.

Pilot program

We're ready.
Are you?

We're inviting a small group of specialist practices to join our 90-day pilot at no cost. You give us access to your real prior auth and denial workflow. We give you measurable time savings and ROI data — or you walk away with no contract and no obligation.

Almvia connected to your EHR via FHIR within the first two weeks.
Prior auth packets and appeal drafts generated automatically from your real cases.
A 90-day report showing time saved per case, denial rate change, and appeal recovery rate.
A direct line to the founding team throughout — this is a research partnership, not a product demo.

We're starting with orthopedics, oncology, cardiology, and neurology practices where prior auth volume is highest. If that's you, we'd like to talk.

Your name

Practice name

Email address

Specialty

Number of physicians

What's your biggest prior auth or denial challenge? (optional)

We're accepting 10 practices. We'll follow up within 48 hours to schedule a 20-minute call. No pitch — just questions about your workflow.