NCCN category criteria. Regimen-level biomarker requirements (HER2, EGFR, PD-L1, MSI/MMR). Peer-to-peer prep with cited evidence. Step-therapy override appeals. Converus assembles the clinical case for every PA — not just fills out a portal.
Generic PA tools treat a first-line lung regimen the same as an orthopedic procedure. Converus understands NCCN categories, biomarker thresholds, and the clinical evidence that moves payers — before the denial arrives.
Converus maps NCCN category recommendations, preferred vs other regimens, and payer-specific coverage rules at the indication level. Every PA is built against the correct evidence tier — not a generic clinical necessity template.
HER2, EGFR, PD-L1 expression, MSI/MMR status — biomarker requirements differ by regimen, payer, and line of therapy. Converus pulls the relevant biomarker data from the chart and maps it to what this payer requires for this specific regimen.
When a payer requests peer-to-peer review, your team needs a tight clinical argument with cited literature — not a chart dump. Converus prepares the P2P brief automatically, with NCCN, ASCO, and PubMed references matched to the denial reason.
PD-L1 expression thresholds, EGFR/ALK exclusions, and payer-specific step therapy requirements vary by plan. Converus maps the correct criteria, pulls biomarker results from the chart, and builds the case before a denial can form.
HER2-targeted agents, EGFR/ALK inhibitors, and KRAS/BRAF-targeted therapies all require documented biomarker test results and matching NCCN criteria. Converus handles the evidence assembly and flags missing biomarker documentation pre-submission.
Off-label regimens are approvable when supported by NCCN compendium listings or published evidence. Converus identifies the applicable compendium citation and builds the documentation to support the clinical necessity argument.
Administrative denials — missing documentation, wrong code, prior auth not obtained — are recoverable but time-intensive. Converus identifies the denial root cause, corrects the documentation, and generates a targeted appeal ready to submit.
Your first 50 cases are on us — real regimens, real payer mix, real denial patterns. See the results before you commit to anything.
First 50 cases free · No commitment · Your payer mix and specialty