Services
Independent Expertise Across Healthcare Review, Compliance, and Advisory Services
EdiPhy Advisors delivers multidisciplinary services to support healthcare providers, payers, and other stakeholders in navigating challenges such as regulatory complexity, documentation of medical necessity, and dispute resolution.
A Customized Approach to Every Engagement
At EdiPhy Advisors, we proactively assess client needs and pain points to deliver services tailored to each engagement. Whether we’re supporting a single case or a complex, multi-faceted initiative, our focus is on long-term partnerships that deliver measurable value to our clients.
Physician Advisor Services
We provide board-certified, actively practicing Physician Advisors who support utilization management, medical necessity determinations, regulatory compliance, and revenue integrity initiatives. Our Physician Advisors work collaboratively with clinical and administrative teams to ensure decisions are clinically sound, compliant, and well documented—so clients can have peace of mind about each step of the journey.
Interested in becoming a Physician Advisor?
Physician Review Services for Compliance Initiatives, Inquiries and Disputes
EdiPhy Advisors provides independent physician reviews to support compliance and regulatory initiatives, inquiries, audits, appeals, and disputes. Our reviews are performed by board-certified physicians with relevant specialty expertise. These services support healthcare organizations, payers, and stakeholders in addressing complex medical and regulatory questions with confidence and credibility.
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Compliance, Denials Management and Appeals
Our team assists clients with ensuring the integrity of denials management and appeals processes. Our approach focuses on better communication between stakeholders and greater adherence to regulatory compliance. Services are customized based on compliance and operational imperatives.
Revenue Integrity and Coding Consultation
EdiPhy Advisors provides revenue integrity, coding, and clinical documentation consultation to support accurate reimbursement and compliance. Services may include documentation and coding assessments, chargemaster and charge capture reviews, and evaluation of billing practices for a variety of providers, payers and other healthcare stakeholders.
Regulatory Compliance and Support
We offer regulatory and compliance support services to help healthcare stakeholders navigate evolving healthcare laws and administrative requirements. Our expertise includes support related to Corporate Integrity Agreements, regulatory inquiries, internal assessments, and responses to government investigations. We partner with our clients to deliver practical solutions informed by expert clinical and legal insight.
Independent Review Organization Services (IRO)
We are a URAC-accredited Independent Review Organization. We provide independent, objective reviews for denials involving medical necessity, experimental and investigational determinations. Our IRO services deliver fair, compliant determinations supported by rigorous clinical and regulatory analysis.
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