Condition Code 44 provides independent medical case review, insurance appeal support, and clinical integration consulting — built for patients, providers, and payers who need a decision they can trust.
Reviewer note —
Prior denial reflects incomplete review of treatment history. Recommend reversal on appeal.
Each engagement is led by clinicians and consultants with direct experience in utilization review, appeals, and health-system operations.
A clinician-led, conflict-free review of diagnosis, treatment plans, or standard-of-care questions — for patients, attorneys, and organizations who need an objective second opinion on the record.
We build the clinical case behind an appeal — organizing documentation, citing medical necessity criteria, and drafting the appeal narrative for denied claims, prior authorizations, and coverage disputes.
For healthcare organizations improving how clinical teams, payers, and administrative workflows connect — care coordination design, utilization review process improvement, and integration strategy.
You share the case details and documentation. We confirm scope, timeline, and which type of review or appeal fits the situation.
A qualified reviewer examines the records against relevant clinical guidelines and medical necessity criteria, independent of any prior decision-maker.
You receive a written opinion or appeal package with clear findings, citations, and recommended next steps.
We remain available to answer questions from payers, providers, or counsel until the case reaches a decision.
Every case and every organization is different, so we scope fees to match — rather than forcing every engagement into one model.
Best for open-ended advisory work — clinical integration strategy, ad hoc reviewer questions, or ongoing organizational support.
Rate discussed per engagementA defined fee for a single independent review or appeal package, scoped once we understand the case complexity and documentation involved.
Quoted after intakeFor health systems and practices that need recurring access to independent review or clinical integration support over time.
Custom monthly termsReviewers at Condition Code 44 are never employed by, or paid based on the outcome of, the payer or provider involved in a case. That separation is the entire point: a review that holds up because nothing about it was steered.
We work directly with patients and families, as well as with attorneys, medical groups, and health plans that need a defensible, well-documented opinion.
Dr. Goyal began his career as a board-certified internal medicine physician, treating patients directly in rural and hospital settings. That clinical foundation carried him into physician leadership — serving as Medical Director and Chief of Staff — and from there into executive roles overseeing revenue cycle, care management, and operations for major health systems. He serves on the board of the South Dakota State Medical Association and now advises organizations on aligning clinical care with financial and operational strategy, bringing that same progression — bedside to boardroom — to every engagement.
Share a few details and we'll follow up to confirm whether we're the right fit, what a review would involve, and how fees would work for it.
Condition Code 44 provides independent clinical review and consulting services and does not provide direct medical treatment or emergency care. Findings are advisory and intended to support — not replace — decisions made by treating physicians, payers, or legal counsel. If you are experiencing a medical emergency, call 911 or your local emergency number.