---
title: "Prior Authorization Review by Physicians | Avandé"
url: "https://avande.net/what-we-do/care-assurance"
description: "Board-certified, specialty-matched physicians review prior authorizations before care happens. Evidence-based criteria; 0.0003% overturned on appeal."
last_updated: 2026-10-09
---

PRE-SERVICE

# Care Assurance Physician-led prior authorization review

Specialty-matched physicians review care before it happens.

- Health plans & TPAs
- Employers
- Providers & ACOs

[Discuss Care Assurance](https://avande.net/contact) 0.0003% OVERTURNED

## The problem

Inappropriate care isn’t only futile. It’s often harmful.

Treatments that were right five years ago may not be best practice today.

Overview

## What we do.

Care Assurance is Avandé’s physician-led prior authorization review. Board-certified, specialty-matched physicians check that requested care is necessary and follows current evidence, before it happens.

### Key benefits

1. Fewer unnecessary procedures SPECIALTY-MATCHED REVIEW
2. Decisions that hold up 0.0003% OVERTURNED ON APPEAL
3. Safer patients CURRENT EVIDENCE-BASED CRITERIA

### WHAT WE CATCH

- Care outside evidence-based guidelines
- Treatments built on outdated assumptions
- Excessive or duplicative testing
- High-cost care with no outcome gain

HOW IT WORKS

## Four steps. One standard.

1. Received

    ### Step 01: Request received

2. In review

    ### Step 02: Specialty matched

3. In review

    ### Step 03: Physician review

4. Determined

    ### Step 04: Determination issued

EVERY STEP RUNS ON ANSERA PORTAL

Results

## Measured, not promised.

0.0003% Decisions overturned on appeal

$0 Balance billing

$1.4M Employer A · one-year savings

CASE STUDY · CS-02

### Notes vs. objective testing

80% obstruction claimed. Records showed 15% and 55%.

$388K Total savings

Why Avandé

## Care, not just claims.

Other vendors check the claim. Our physicians check the care, before it happens.

- SOC 2 Type II
- HIPAA
- BAA
- PHI Protection

typical vendor compared with Avandé
| TYPICAL VENDOR | AVANDÉ |
| --- | --- |
| Reviews the claim | Reviews the clinical care |
| Validates coding | Validates medical necessity |
| Applies rules | Applies physician judgment |
| Accepts claims at face value | Verifies the documentation |

FAQ

## Straight answers.

### How often are decisions overturned?

Rarely. 3 out of 10,000 cases (0.0003%) are overturned on appeal.

### Who makes the determination?

A board-certified physician in the same specialty as the requested care.

### What criteria do you use?

Evidence-based clinical guidelines, cited in every determination.

### Do you support peer-to-peer reviews?

Yes. Specialty-matched physicians are available for peer-to-peer discussions.

Talk to a physician-led team

## Discuss Care Assurance.

A few sentences are enough.

[Let's Talk](https://avande.net/contact) or call **1-833-328-2633**

## More ways we help

- POST-SERVICE

    ### Forensic Claims Validation

    Explore

    [Forensic Claims Validation](https://avande.net/what-we-do/forensic-claims-validation)

- ONGOING

    ### Clinical Surveillance

    Explore

    [Clinical Surveillance](https://avande.net/what-we-do/clinical-surveillance)

- TECHNOLOGY

    ### Healthcare IT Services

    Explore

    [Healthcare IT Services](https://avande.net/what-we-do/healthcare-it-services)