Question 1

1. What types of denials does Nolvium support?

Accepted Answer

Nolvium specializes in medical-necessity denials (including CO-50 and CO-197 claim remittance codes) for surgical and interventional orthopedic procedure claims. It matches uploaded patient charts against controlling payer clinical policy rules to identify supporting evidence or documentation gaps.

Question 2

2. Which Medicare MACs are supported?

Accepted Answer

Nolvium supports Medicare Part B across all 7 regional Medicare Administrative Contractors (MACs): Noridian Healthcare Solutions, Novitas Solutions, Palmetto GBA, National Government Services (NGS), First Coast Service Options (FCSO), WPS Government Health Administrators, and CGS Administrators. Support varies by procedure, jurisdiction, policy status, and available documentation.

Question 3

3. Which orthopedic procedures are supported?

Accepted Answer

Nolvium supports key orthopedic procedures including CPT 29881 (Knee arthroscopy & meniscectomy), CPT 29827 (Arthroscopic rotator cuff repair), CPT 63030 (Lumbar discectomy or laminotomy), CPT 20610 (Major joint injection/aspiration, including selected hyaluronic-acid workflows), CPT 27447 (Total knee arthroplasty), and CPT 29806 (Shoulder capsulorrhaphy or labral repair).

Question 4

4. Do you support commercial payers?

Accepted Answer

Yes. Nolvium supports selected commercial payer clinical policies from organizations such as UnitedHealthcare, Aetna, Cigna, and Blue Cross Blue Shield plans. Commercial payer support is available for selected policies where criteria can be reliably mapped, as commercial plans may have different documentation requirements, exclusions, and authorization rules than Medicare.

Question 5

5. Does Nolvium submit appeals automatically?

Accepted Answer

No. Nolvium does not submit any appeal automatically. A qualified practice user (such as a certified biller, clinical auditor, or practice manager) reviews, edits, and approves every packet before copying, downloading, and submitting it through their existing payer portal or clearinghouse workflow.

Question 6

6. Does a human review every appeal?

Accepted Answer

Yes. Nolvium operates strictly as a decision-support and drafting copilot. It prepares the policy-cited evidence matrix and appeal draft, but a human billing or clinical professional must review and approve every final packet before submission.

Question 7

7. Can every statement be traced to the patient chart?

Accepted Answer

Yes. Source-level evidence traceability is one of Nolvium's primary differentiators. Every clinical assertion, conservative treatment milestone, examination finding, imaging conclusion, medication item, and date is linked to the exact source document name, page number, section, service date, and quoted excerpt (e.g., 'Clinical Chart, PDF 2, page 14, Physical Therapy Note dated 04/18/2026').

Question 8

8. What happens when documentation is missing?

Accepted Answer

Nolvium follows a strict 'No Evidence, No Assertion' rule. The system does not infer that a clinical requirement was satisfied merely because it is likely. When required evidence is absent or unclear, Nolvium marks the criterion as unresolved and inserts an explicit warning in the draft (e.g., '[ACTION REQUIRED: Supporting documentation for the required conservative-care period was not located. Review the patient record before submission.]').

Question 9

9. How is PHI processed?

Accepted Answer

Uploaded clinical documents are processed in transient execution memory buffers and are not retained in the application's permanent document store after session completion, subject to documented operational logs, security controls, and any files intentionally exported by the user.

Question 10

10. Is a Business Associate Agreement (BAA) available?

Accepted Answer

Yes. A Business Associate Agreement is available for eligible covered entities, practices, billing services, and other customers before live PHI processing.

Question 11

11. Does Nolvium integrate with Epic, Athenahealth, EMA, or AdvancedMD?

Accepted Answer

In the current release, Nolvium does not have active bi-directional API integrations with Epic, athenahealth, Modernizing Medicine/EMA, or AdvancedMD. Users operate via a zero-setup document-upload workflow by exporting the EOB/ERA and chart PDFs from their existing system, uploading them to Nolvium, and returning the reviewed packet to their normal workflow.

Question 12

12. How does the current upload workflow work?

Accepted Answer

Users upload the denial ERA/EOB and chart PDFs, Nolvium parses the claim and matches the policy, displays an Evidence Matrix, generates a draft, and the user reviews, edits, copies or downloads the final packet to submit through their clearinghouse or payer portal.

Question 13

13. Does Nolvium track appeal deadlines?

Accepted Answer

Yes. The current release includes basic static timeline calculation based on applicable rules. For Medicare redeterminations, the general deadline is 120 days from receipt of the ERA or remittance notice. The system displays its assumptions and allows manual overrides.

Question 14

14. Does Nolvium track whether an appeal was paid or overturned?

Accepted Answer

In the current release, Nolvium focuses on parsing-to-packet generation and basic deadline calculation. Longitudinal outcome analytics (tracking paid, denied, overturned status, recovered dollars, and time to resolution) are planned on our future roadmap.

Question 15

15. Can Nolvium guarantee reimbursement?

Accepted Answer

No. Nolvium supports administrative, billing, and documentation-review workflows. It does not guarantee payer reimbursement, as final claim adjudication remains at the sole discretion of the payer.

Question 16

16. Is Nolvium a medical or legal decision-maker?

Accepted Answer

No. Nolvium is an administrative decision-support tool. It does not provide medical diagnosis, replace clinical judgment, or provide legal advice.

Question 17

17. How often are policy sources updated?

Accepted Answer

Nolvium performs scheduled policy reviews at least quarterly and monitors CMS and MAC coverage-document changes throughout the year. Critical revisions are prioritized for review within 48–72 hours.

Question 18

18. What is the current supported policy coverage?

Accepted Answer

Nolvium supports Medicare Part B across 7 regional MACs and selected commercial payer policies for supported orthopedic CPT procedure codes. Coverage varies by procedure, jurisdiction, and available payer documentation.

Frequently Asked Questions.