For institutions
Denials don’t stop at diagnosis. Neither should the proof.
Dearbh turns a denied claim into a cited appeal. It finds the rule that governs the denial, pulls the facts out of the letter, and quotes every source word for word. For a team carrying a caseload, it does that across a queue instead of one letter at a time.
Manufacturer patient access · Hub services · Specialty pharmacy · Rare disease clinics · Behavioral health groups
Who runs this
Built for the teams already doing this job.
Hub services and advocacy teams do the human work of managing a case. Dearbh is the engine underneath. It finds the rule, pulls the facts from the denial letter, and proves every citation against its source, so the people already doing this work can carry more cases without lowering the bar on what goes out the door.
Rare disease clinics & COEs
Give your specialists a tool that records the denial patterns your own patient population runs into, so the next appeal on the same therapy starts from what the last one proved.
Manufacturer patient access
Get orphan therapies approved and paid for, with a citation trail your reimbursement team can defend to any payer.
Hub services
Run appeals for every manufacturer program you support from one queue, sorted by what is actually at risk.
Specialty pharmacy
Clear prior-auth and renewal denials on high-cost therapies before a fill gets delayed.
Behavioral health groups
Answer parity denials with the rule itself. When a plan reviews mental health care more strictly than it reviews medical care, that comparison is the argument, and it has to be quoted rather than asserted.
How the workflow runs
Four steps, in the order that builds a case correctly.
Not a single upload box. A queue built for the volume and the stakes of rare disease work.
Denials land in one queue
Batch upload, or a direct feed from your existing intake system. Nothing waits in someone’s inbox.
Triage by what is at stake
Sorted by therapy value and time to lapse, not upload order, so a gene therapy denial does not sit behind a routine renewal.
Draft with proof, assigned to a reviewer
Dearbh finds the rule, pulls the facts, and quotes every source word for word. A named person signs off before anything sends.
Outcomes roll up automatically
Overturn rate, time to decision, and value recovered, by disease and by drug, ready for whoever you report to.
One line, traced to source
What one appeal line looks like.
A denial letter usually gives several reasons at once. Dearbh answers each one separately: its own rule, its own records, its own entry in the file. These four run on different law on purpose — an employer plan, a marketplace plan and Medicaid each answer to a different rulebook, and the engine works out which one governs a case before it writes a word.
Insurer says
“The records you sent do not support the therapy you asked for.”
Dearbh finds
Your plan has to tell you exactly what was missing, not just that something was.
“The notification shall set forth, in a manner calculated to be understood by the claimant— (i) The specific reason or reasons for the adverse determination; (ii) Reference to the specific plan provisions on which the determination is based; (iii) A description of any additional material or information necessary…”
You get
Documents received
- Your therapist’s progress notes
- Your doctor’s order for therapy
Documents outstanding
- The plan’s written list of exactly what it says is missing Dearbh drafts the requestUntil the plan names it, there is nothing to answer. This turns a vague no into a specific one.
- The visit notes for the sessions already refused Dearbh drafts the requestThese show the therapy was given and what it achieved, which is what the plan says it cannot see.
You can file now.
The plan has to say exactly what was missing, and it did not. Dearbh drafts that letter and the record request together, so the clock keeps running while the notes arrive.
Insurer says
“Our review criteria do not support more therapy sessions.”
Dearbh finds
The rules a plan applies to mental health care cannot be stricter than the ones it applies to medical care.
“In the case of a group health plan … that provides both medical/surgical benefits and mental health or substance use disorder benefits and that imposes any nonquantitative treatment limitation on mental health or substance use disorder benefits…”
You get
Documents received
- Your treatment plan
Documents outstanding
- The plan’s own limits on medical and surgical care, to compare Dearbh drafts the requestParity is a comparison. Without the medical side, there is nothing to hold the mental-health limit against.
- Your clinician’s notes for the sessions already refused Dearbh drafts the requestThey show what the treatment is doing, which is what a review-criteria denial disputes.
- The written criteria the plan says you did not meet Dearbh drafts the requestThe plan has to produce them. You cannot show a rule was applied more strictly if nobody will show you the rule.
You can file now.
Parity stands on its own. Dearbh drafts the appeal and, at the same time, asks the plan for its medical and surgical limits, because the comparison is what carries it.
Insurer says
“This drug is not on your plan’s list of covered drugs.”
Dearbh finds
Your plan has to give you and your doctor a way to ask for a drug it does not cover.
“A health plan providing essential health benefits must have the following processes in place that allow an enrollee, the enrollee’s designee, or the enrollee’s prescribing physician … to request and gain access to clinically appropriate drugs not otherwise covered by the health plan (a request for exception).”
You get
Documents received
- Your prescription
- The drugs you have already tried
Documents outstanding
- Your doctor’s written justification for this drug Dearbh drafts the requestThis is the centre of the appeal. It is what says this drug, for this patient, for this reason.
- Notes on how the covered alternatives worked, or why they cannot be used Dearbh drafts the requestA formulary denial assumes something else will do. This is what answers that.
- The plan’s formulary showing what it covers in this class Dearbh drafts the requestIt shows whether the plan covers anything at all here, which is the point the rule turns on.
- The plan’s written decision on your exception request Dearbh drafts the requestWithout it there is no decision to appeal, and the clock may not have started.
Get one thing first.
Your doctor’s written justification is the strongest thing missing. Dearbh drafts the request for it. If your deadline is close, it files to protect the date and adds the justification to the file after.
Insurer says
“Your home health hours are being cut.”
Dearbh finds
You have a right to a fair hearing when a claim is denied or is not acted on.
“Section 1902(a)(3) of the Act requires that a State plan provide an opportunity for a fair hearing to any person whose claim for assistance is denied or not acted upon promptly.”
You get
Documents received
Nothing in your file supports this yet. Dearbh will not write a line it cannot back, so it asks for these first.
Documents outstanding
- The notice stating the reason and the date the cut starts Dearbh drafts the requestEverything runs from this. It carries the reason, the rule, and the date your deadline counts from.
- Your plan of care Dearbh drafts the requestIt is what set the hours in the first place. Without it there is nothing to measure the cut against.
- Your nurse’s assessment of the hours you need Dearbh drafts the requestThis is the clinical answer to why the hours are needed, which is what the cut disputes.
- The state rule the plan says it is applying Dearbh drafts the requestThe plan has to name the rule. Until it does, no one can show it was applied wrongly.
- The plan’s own decision on your appeal to it Dearbh drafts the requestWith a managed-care plan the plan’s appeal usually comes first, and its decision is what opens the state hearing. Filing in the wrong place can cost you the deadline.
Not ready to file.
Dearbh will not tell you this appeal is backed when nothing in your file supports it. Get the notice and your plan of care first. If the deadline is close, Dearbh files to protect the date and says plainly, in the letter, which records are still coming.
Each tab shows one line of an appeal. A real denial letter usually gives several reasons at once. Dearbh answers every one of them separately. Each line gets its own rule, its own records, and its own entry in the file, so you can see what backs it and nothing in the letter goes unanswered.
Which rule governs depends on the kind of plan you have. These four run on different law: an employer plan, a marketplace plan and Medicaid each answer to a different rulebook. Dearbh works out which one applies to you before it writes a word.
Product preview
The queue your team actually works from.
A wireframe of the institutional triage view, sorted by value at risk and time to lapse, not by when it arrived. Every case, therapy, name and figure below is invented for this illustration.
| Case | Therapy value | Days left | Assigned | Status |
|---|---|---|---|---|
| Case 0412Pompe disease · ERT dosing denial | $412K / yr | 3 | M. Alvarez | High value |
| Case 0409Duchenne MD · gene therapy prior auth | $3.1M one-time | 6 | Unassigned | High value |
| Case 0407Fabry disease · infusion renewal | $260K / yr | 11 | J. Okafor | In review |
| Case 0403Power wheelchair · routine renewal | $8.4K | 19 | M. Alvarez | Standard |
Everything you were going to ask
Answered before the call, not during it.
If your question is not here, bring it to the briefing. We would rather answer it on the record than in a follow-up email.
What is Dearbh for institutions?
An appeal engine for manufacturer patient access teams, hub services, specialty pharmacies, and rare disease clinics. Every claim in the appeal is proven word for word against the real policy, regulation, or coverage rule it cites, and a person reviews the calls that matter before anything sends.
How is this different from a hub service or an advocacy team?
Those teams do the human work of managing a case. Dearbh is the engine underneath: it finds the rule, pulls the facts, and proves the citations, so the people already doing this job can carry more cases without lowering the bar.
Does patient data leave our network?
Not unless you ask for it. Dearbh is built local first: the case is assembled on the machine in front of you, and a case is only stored somewhere else if you choose that and say so. Institutional deployment runs in your own environment, in your own cloud account, so patient records stay inside the boundary you already control.
What does it cost?
Scoped to your case volume and to whether you need deployment in your own environment, a shared knowledge base across your team, and outcome reporting. You will have a number before you leave the briefing call.
Can it handle rare disease appeals, not just routine ones?
That is the point. A rare disease appeal turns on specifics a generic appeal tool is not built to retrieve: the label, the orphan designation, the trial data, the specialty society guideline. Dearbh retrieves against the disease and the drug in question, and it records what each appeal proved, so the next one on the same therapy does not start from nothing.
Will it write something it cannot back up?
No. If the record that would support a line is not in the file, Dearbh says so and asks for it rather than writing the line anyway. If a deadline is close it files to protect the date and states plainly, in the letter, which records are still coming.
Request a briefing
Bring us a denial you’re still fighting.
We will show you what Dearbh finds in it before you tell us anything else. Thirty minutes, your case, your rulebook.
Please don’t send patient records with the request. A briefing is not where a case lives. Email [email protected].
Join the waiting list
Dearbh is in live testing and verification review now. Tell us who you are and we will let you know the moment it opens. If your team wants to help shape it, you can ask to join the group that tries it first. For a walk-through of a live denial instead, request a briefing above.
We ask for the type of denial only as a category, so we know which problems to build for first. Please do not send us medical records or case details here — this page is not where a case lives.