Progress note · excerptToday, 2:14 PM
Pt seen for right knee pain. Knee brace prescribed. RTC 4 wks.
DeniedUR determination: medical necessity not established — clinical justification absent from documentation.
Workers' Comp DME Regulatory Intelligence
The right clinical decision still gets denied.
In workers' compensation, DME approval lives or dies on documentation — and the justification is usually in the provider's head, not in the note. Proviant captures that clinical reasoning at the point of care and turns it into payer-ready medical-necessity language in about 90 seconds.
Now onboarding a limited group of California workers' comp practices.
Proviant · generated justification92 seconds
The patient presents with right knee strain involving the right knee. Reported symptoms include pain and instability. Physical examination demonstrates reduced range of motion and tenderness. These findings result in significant functional limitations including walking. Mechanical instability noted on examination necessitates external stabilization… A knee orthosis is indicated to provide structural support, limit pathological motion, and facilitate right knee function. This injury is work-related, and the DME is directly necessary to facilitate return to occupational function.
Payer-readyEvery element utilization review looks for — symptoms, objective findings, functional limitations, work-relatedness — in one copy-ready note.
6 of 33
DME orders approved in one real supplier caseload — an 18% approval rate under today's manual documentation.
$3,388
A single prescribed device denied because the clinical note never mentioned it.
~35%
Typical first-pass DME approval when justification is missing from documentation.
90 sec
From diagnosis to a complete, copy-ready medical-necessity note — during the visit.
How it works
Diagnosis in. Payer-ready justification out.
No new system to learn, no EHR integration required. The provider — or their staff — clicks through a guided clinical checklist, and the note is ready to paste before the patient leaves the room.
STEP 1
Start with the diagnosis
Select the ICD-10 code. The injured body part derives automatically, and the tool surfaces only the clinical questions relevant to that diagnosis and device family.
STEP 2
Document the clinical chain
Check off patient-reported problems, exam findings, functional limitations, and comorbidities. Built-in validation flags weak links — a symptom without objective support, pain without functional impact — before they become denial reasons.
STEP 3
Copy the note
A structured medical-necessity justification, with suggested HCPCS codes, ready to paste into your EMR and sign. The provider reviews and approves every word.
The medical-necessity chain, enforced
Diagnosis → Patient-reported problems → Objective findings → Functional limitations → Risks & clinical goals → DME solution → Payer-ready justification
The intelligence layer
It knows what the reviewer will check.
Every state runs on a hierarchy of medical treatment guidelines — and utilization review follows it precisely. Lookup tools can tell a physician whether a treatment meets guideline. None of them tell you what your note has to say to get it approved.
Proviant encodes the guideline hierarchy and the documentation requirements behind it, starting with California — so the note is built for the review it will face.
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1
MTUS / ACOEM — California's primary guideline
If the treatment is addressed here, following it is required by law. The note cites what the guideline expects.
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2
ODG — the required second check
When MTUS is silent on an item, California requires the prescriber to address ODG. The system knows when that applies.
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3
Evidence path — when both are silent
Even "not addressed" items have a documented path to approval. The note builds the clinical case the reviewer needs to say yes.
The clinician stays in control
The tool elicits documentation — it never dictates treatment. Every note is reviewed and signed by the provider.
Clinically justified, not gamed
Built to document appropriate care completely — not to manufacture approvals for equipment a patient doesn't need.
Brand-neutral
Justifications are written for device categories, not brands. No steering, no kickback-shaped workflows.
No PHI stored
Notes are generated and copied into your own system. Patient identifiers are never required — and flagged if entered.
Early access — California
Help us prove what better documentation is worth.
We're onboarding a small group of California workers' comp practices and DME partners as early adopters. Pilot participants get the tool free during the pilot, direct input on what it becomes, and first access as it expands.
- Prescribe DME under California workers' comp (bracing, cold therapy, e-stim, PEMF)
- Use it in real visits — it takes about 90 seconds per note
- Tell us where it's wrong. That's the point of the pilot.