Defensible medical necessity analysis for appeals and reviews.
Omni Health NP provides record-based clinical analysis and policy-aligned rebuttal narratives to support Medicare appeals (2nd–4th level) and related medical review workflows. Services are delivered by licensed clinicians and designed for contractor and institutional use.
Appeals support and medical necessity review are treated as structured, repeatable deliverables—built for consistency, QA, and turnaround.
Turnaround and volume can be aligned to contract requirements.
Services
Designed for CMS-aligned programs requiring consistent documentation, objective analysis, and clear linkage between medical records and policy criteria.
Medicare appeals support
Clinical analysis and narrative support for 2nd–4th level appeals, including medical necessity justification and defensibility review.
Medical necessity review
Record-based evaluation aligned to applicable CMS policy and coverage criteria (e.g., LCD/NCD/manual guidance), as scoped by program.
QA / second-look review
Secondary review for completeness, internal consistency, and policy alignment before submission into contractor workflows.
Scope and exclusions
Included
- Record-based clinical summarization
- Policy-aligned medical necessity reasoning
- Structured rebuttal narratives (as required)
- Defensibility and completeness checks
Not included
- Direct patient care or treatment recommendations
- Patient scheduling or clinical follow-up
- Claims submission, billing, or collections
- Legal representation or testimony unless separately contracted
Independence
- No treating-provider relationship is established
- Conflict screening supported as required by program
- Work product delivered within contractor templates
How engagement works
A lightweight onboarding process built for contractor workflows.
Credentialing
Share program requirements. Omni Health NP provides licensure, identity verification, and other credentialing items as needed.
Template alignment
Work is delivered in your required structure and tone (objective, policy-aligned, and defensible) with agreed turnaround targets.
Case delivery
Cases are reviewed based on provided records and criteria. Outputs are returned via your specified secure channel.
Credentials and positioning
Use this section to present your credentials accurately, without marketing claims.
Clinician
- Doctor of Nursing Practice (DNP)
- FNP-BC (or relevant board certification)
- Licensed in: NY (add additional states as applicable)
Clinical domains
- Family medicine / primary care
- Complex chronic disease documentation
- Medical necessity reasoning and narrative synthesis
Operational
- Structured deliverables and QA mindset
- Reliable turnaround and communication
- Secure document handling practices
Contact
For credentialing, onboarding, and contractor inquiries.
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