Denials & Appeals
Get Paid on Claims That Came Back Denied
Each denial is traced back to the criterion it was decided under, then drafted into an appeal that cites the governing policy and the documentation already in the record.
What it does
Most denials are lost to time, not merit
Appeals get abandoned because reconstructing the argument takes longer than the claim is worth. This shortens that work rather than promising an outcome.
The reason, in policy terms
A denial code is not an explanation. Each denial is matched to the policy it was decided under, so the appeal argues the criterion the payer actually applied.
Drafted appeal letters
The letter cites the governing LCD or NCD language and points at the documentation already in the record. You edit and sign it; it is a draft, not an automatic filing.
Windows and levels tracked
Appeal deadlines are short and vary by level. Each denial carries its own window and current level, from redetermination onward, so nothing lapses unnoticed.
Triage
Not every denial should be appealed
Sorting the three cases up front is what keeps a billing team's time going to the claims that will actually come back.
Worth appealing
Denials where the documentation already supports the criterion and the argument is available in the record.
Fixable first
Denials caused by a gap that can be addressed, then resubmitted rather than appealed.
Not worth the hour
Low-value denials where the staff time costs more than the claim returns. Saying so is part of the job.
How it works
From denial letter to filed appeal
Every letter is a draft for your billing team to review. Nothing is submitted to a payer automatically.
- 01
Start from the letter
Upload the denial letter. The reason codes and the claim it refers to are read from it.
- 02
Identify the reason
The denial is matched to the policy and criterion behind the decision.
- 03
Draft the appeal
A letter is assembled citing the policy language and the supporting documentation.
- 04
File and track
Submit, then follow the outcome so the next appeal to that payer is better informed.
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