Physician-led NICU medical necessity, pediatric utilization review, and denial management for pediatric hospitals.
We sit with the data your team is buried in — turning denial patterns into overturned claims and fewer denials next month.
Most advisors know clinical criteria. Few can also build the financial model behind a denial and sit across the table from a payor to overturn it. MAX does both, with deep pediatric and NICU-level expertise.
Experience building the financial models behind denials and negotiating directly with payors — so appeals are backed by data, not just clinical opinion.
Standing monthly meetings with major payors to review denials data, surface patterns, and resolve disputes before they compound.
Hands-on familiarity with NICU care and medical necessity — the highest-stakes, most scrutinized level of pediatric review.
Targeted physician-advisor support across the points where pediatric and NICU claims are won or lost.
Physician-level review of admission status and level of care to confirm medical necessity is documented and defensible before claims go out.
Discuss status reviewsAssessment of incoming denials to identify which are clinically and financially worth pursuing to peer-to-peer — so your team spends effort where it pays off.
Discuss denial reviewsDirect physician-to-physician peer reviews with payors, argued with clinical evidence and the financial context behind the case.
Discuss peer-to-peersRoot-cause analysis of what's driving your denials, turning monthly payor data into upstream fixes that reduce future denials.
Discuss denial driversTell us about your hospital, your NICU, and where denials are hurting most. We'll review and set up a call.
We dig into your denials and payor patterns to find what's pursuable now and what's driving the volume.
We handle status reviews and peer-to-peers, then feed root causes back upstream to prevent the next wave.
Built for pediatric hospitals — especially those with a NICU — that need physician-advisor firepower without a full in-house team.
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