Question 1

What is Avande?

Accepted Answer

Avande is a healthcare cost management company with over 25 years of experience helping health plans, TPAs, self-funded employers, and reinsurers reduce healthcare costs while improving clinical outcomes. We combine physician-led clinical expertise with purpose-built technology to deliver measurable savings across prior authorization, cost containment, health plan optimization, and healthcare IT.

Question 2

Who does Avande serve?

Accepted Answer

We serve health plans and TPAs managing utilization and cost, self-funded employers seeking to reduce healthcare spending, reinsurance and stop-loss carriers needing medical case review, and legal and compliance teams requiring clinical expertise for healthcare disputes. Our solutions scale from mid-sized employer groups to large national health plans.

Question 3

How do I get started with Avande?

Accepted Answer

Start by scheduling a free consultation with our team. We'll conduct a no-obligation assessment of your current healthcare cost challenges, provide initial savings estimates, and develop a customized proposal. Most engagements begin delivering value within 60-90 days of agreement.

Question 4

How is Avande different from traditional healthcare vendors?

Accepted Answer

Three key differentiators: (1) Every clinical determination is made by board-certified, specialty-matched physicians—not nurses or algorithms. (2) Our technology platform is purpose-built for healthcare with 25+ years of domain-specific development, not generic workflow tools adapted for healthcare. (3) Our pricing aligns with your success—we benefit when you save, not when you spend more.

Question 5

What certifications and compliance standards does Avande maintain?

Accepted Answer

We maintain SOC 2 Type II, HIPAA, and HITRUST certifications with annual third-party audits. All systems are architected with compliance from day one, including encryption at rest and in transit, role-based access controls, complete audit trails, and US-based data centers.

Question 6

Does Avande offer a risk-free engagement model?

Accepted Answer

Yes. We offer risk-free assessments for most services. For cost containment, our contingency-based pricing means you only pay when we recover money. For health plan optimization, we provide free comprehensive plan analysis with savings projections before any commitment. We're confident in our ability to deliver measurable results.

Question 7

How quickly can prior authorization implementation begin?

Accepted Answer

Standard implementation takes 4-6 weeks including integration testing and training. Expedited implementations can be completed in 2-3 weeks. The cloud-based SaaS platform requires no hardware installation.

Question 8

What medical specialties does Avande cover for prior authorization?

Accepted Answer

We provide board-certified physician reviewers across 30+ medical specialties including cardiology, oncology, orthopedic surgery, neurology, pulmonology, and all major medical and surgical subspecialties.

Question 9

Are reviewers actual practicing physicians?

Accepted Answer

Yes. All determinations are made by board-certified physicians who maintain active medical licenses and clinical expertise in their specialty. Many still practice clinically part-time, ensuring current medical knowledge.

Question 10

What is the average turnaround time for prior authorization?

Accepted Answer

Standard turnaround is 24-48 hours from receipt of complete documentation. Expedited reviews are completed within 24 hours. Urgent cases are processed same business day.

Question 11

What happens if a prior authorization is denied?

Accepted Answer

All denials include detailed clinical rationale from the reviewing physician, specific criteria not met, clear appeal rights, and peer-to-peer review option with a same-specialty physician. Every denial undergoes peer review before issuance.

Question 12

How much can we expect to recover through cost containment?

Accepted Answer

Mid-sized health plans (100K-500K members) typically recover $2-4M annually. Recovery amounts vary based on claims volume, claim types audited, and historical payment accuracy. We provide recovery estimates after initial data analysis.

Question 13

What types of overpayments does Avande identify?

Accepted Answer

We identify duplicate payments, incorrect fee schedules, coding errors (unbundling, upcoding), coordination of benefits (COB) errors, contract rate violations, medically unnecessary services, and fraud schemes. Both post-payment recovery and pre-payment prevention.

Question 14

Will cost containment damage our provider relationships?

Accepted Answer

No. Our professional approach maintains positive provider relations. We provide complete clinical documentation for all findings, offer peer-to-peer discussions, and handle negotiations respectfully. Many providers appreciate education on billing errors.

Question 15

How is Avande's approach different from automated claim edits?

Accepted Answer

Automated edits catch basic errors at point of payment. Our forensic analysis reviews already-paid claims using advanced analytics, physician validation, and certified coder expertise to identify complex patterns, fraud schemes, and errors that simple edits miss.

Question 16

Can you help prevent future overpayments?

Accepted Answer

Yes. Every engagement includes recommendations for process improvements, suggested claim edits, provider education, and contract clarifications to prevent future overpayments. Many clients implement pre-payment controls based on our findings.

Question 17

Will my employees lose access to their doctors and hospitals?

Accepted Answer

No. Your employees will have access to the same national provider networks available through major carriers like UnitedHealthcare, Aetna, Cigna, and Humana. Before any transition, we verify that all employee providers are in-network. Network equivalency is guaranteed.

Question 18

How much can we expect to save with Claims Surveillance?

Accepted Answer

Most employer groups save 20-35% compared to traditional carrier renewals in the first year, with stable 3-5% increases in subsequent years (vs typical 8-15% carrier increases). We provide detailed savings projections during the free plan analysis.

Question 19

Is this too good to be true? What's the catch?

Accepted Answer

No catch. The savings come from three sources: (1) Eliminating carrier administrative markups and profit margins, (2) Proactive medical case management that prevents unnecessary costs, and (3) Transparent pricing with no hidden fees. Traditional carriers build profit into premium costs; we use a transparent fee structure aligned with your savings.

Question 20

How is this different from just switching to another insurance carrier?

Accepted Answer

Avande is NOT an insurance carrier. We provide the clinical expertise and medical management layer that sits between you and plan administration. You get the same national networks as major carriers, but with proactive physician oversight, cost containment, and transparent pricing.

Question 21

What does the Claims Surveillance transition process look like?

Accepted Answer

Implementation typically takes 60-90 days: (1) Free comprehensive plan analysis with savings projections, (2) Network verification for all employees, (3) Custom plan design and pricing, (4) Employee communication and education, (5) Seamless transition with dedicated support. Employees experience zero disruption to ongoing care.

Question 22

What makes Avande different from other IT outsourcing firms?

Accepted Answer

Healthcare domain expertise. Our teams understand claims adjudication, clinical workflows, HL7 FHIR, X12 EDI, and healthcare regulatory requirements—not because they learned it for your project, but because healthcare is all we do. We've spent 25+ years building proprietary healthcare technology platforms.

Question 23

Can you help us modernize legacy systems without disrupting operations?

Accepted Answer

Yes. We specialize in incremental modernization strategies: API wrapping, microservices migration, cloud migration, and phased replacement. Our approach minimizes operational disruption through parallel runs, feature flags, and zero-downtime cutover strategies.

Question 24

Do you provide true 24/7/365 support coverage?

Accepted Answer

Yes. Our blended onshore/nearshore/offshore delivery model spans multiple time zones, providing genuine around-the-clock coverage. When the U.S. team ends their day, offshore teams continue development and support—ensuring healthcare systems never go unsupported.

Question 25

What healthcare interoperability standards do you support?

Accepted Answer

Full support for HL7 v2, HL7 FHIR R4 (CMS interoperability mandates), X12 EDI (837, 835, 270/271, 834), CCD/C-CDA, and NCPDP. We build and consume FHIR APIs for EHR integration, HIE connectivity, and payer interoperability.

Question 26

What engagement models do you offer?

Accepted Answer

Flexible models: (1) Project-Based for defined initiatives, (2) Dedicated Team as an extension of your IT department, (3) Staff Augmentation to fill skill gaps, (4) Managed Services for ongoing support, (5) Advisory/Assessment for technology roadmaps. We tailor the model to your needs.

Question 27

How does Avande protect patient data (PHI/PII)?

Accepted Answer

All Protected Health Information and Personally Identifiable Information is handled according to HIPAA Security Rule requirements. This includes role-based access controls, minimum necessary access principles, complete audit trails of all data access, workforce training, and incident response procedures. PHI is never stored on local devices or transmitted via unencrypted channels.

Question 28

What security certifications does Avande hold?

Accepted Answer

We maintain SOC 2 Type II, HIPAA, and HITRUST certifications verified through annual independent third-party audits. Our infrastructure meets or exceeds requirements for ISO 27001, NIST Cybersecurity Framework, and CMS security standards. Audit reports are available to clients under NDA.

Question 29

How is data transmitted and stored securely?

Accepted Answer

All data is encrypted using AES-256 at rest and TLS 1.2+ in transit. Data is stored exclusively in US-based, SOC 2 certified data centers with geographic redundancy. We support secure data exchange via SFTP, encrypted API connections, and HL7/FHIR secure endpoints. Regular penetration testing validates our security posture.

Question 30

Does Avande execute Business Associate Agreements (BAAs)?

Accepted Answer

Yes. We execute HIPAA Business Associate Agreements with all clients as a standard part of engagement. Our BAA covers all Avande systems, personnel, and subcontractors involved in handling client PHI. We also maintain BAAs with all downstream technology and service providers.

Frequently Asked Questions

About Avande

Prior Authorization Management

Cost Containment & Recovery

Claims Surveillance

Healthcare IT Services

Security & Compliance

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