Avandé

Avandé is a healthcare B2B company that provides medical management and clinical decision support services to insurance companies, third-party administrators, stop-loss insurers, accountable care organizations, employers, and health plans. The company combines board-certified physician expertise with proprietary cloud-based technology to conduct medical necessity reviews, prior authorizations, claims scrubbing, and forensic reviews.

The company operates with a network of more than 60 board-certified physicians across 25+ medical specialties who review cases from clinical, regulatory, legal, and financial perspectives. Avandé uses artificial intelligence and machine learning algorithms that analyze medical and utilization data against evidence-based clinical practice guidelines. The platform converts unstructured healthcare data into structured information for physician analysis and decision-making.

Avandé has reviewed over $3.1 billion in claims and maintains international experience across North America, Latin America, Asia, and Europe. The company is SOC 2 compliant and HIPAA compliant, with healthcare data security and privacy protections built into its platform architecture.

Choose Avandé when you need physician-level clinical expertise backing your utilization management decisions, particularly for complex or high-dollar medical cases that may require legal defensibility. The company's multi-specialty physician network and comprehensive review methodology spanning clinical, regulatory, legal, and financial dimensions make it appropriate for organizations with sophisticated medical management needs.

Expect a technology-enabled service model where AI and machine learning support physician decision-making rather than replacing it. The cloud-based platform provides data access and customizable workflows, though prospective clients should inquire about integration requirements with existing claims and authorization systems.

Avandé operates exclusively in healthcare, providing medical management services specifically for payers, insurers, and employers managing healthcare benefits. The company's entire service model is built around healthcare utilization management, with physician reviewers trained in HIPAA compliance, FDA regulations, and Department of Health and Human Services requirements. Expertise spans clinical specialties from cardiology and oncology to transplantation and behavioral health, with specific focus on medical necessity determination, prior authorization, and claims review within healthcare payment contexts.

The ideal client is a mid-to-large payer organization, TPA, or self-insured employer managing complex medical claims requiring physician-level clinical review. Organizations assuming greater risk through value-based arrangements, those facing high-cost outlier cases, or entities requiring legally defensible medical necessity determinations across multiple specialties will benefit most from Avandé's comprehensive review capabilities.