Appeals

Starting an appeal

On a Denied or Partially approved request, choose Start appeal and confirm. The request becomes Appeal in progress. The payer's decision must be recorded first, since the appeal is built on it; see Recording submission and outcomes.

Add new information

Context is editable again in the appeal stage. Add whatever is new since the decision: a letter of medical necessity from the provider, further findings, results of the treatment tried since. The page tells you when nothing has been added since the decision. An appeal built on the same notes is unlikely to persuade anyone.

Generate the appeal

Generate appeal drafts from:

• the original packet, always the starting point;
• the previous appeal, if this is a later round;
• the payer's stated reason for the latest decision;
• notes and findings added since that decision.

It uses the same safeguards as the first packet: an allowance check first, identifiers removed (including from the stored packet and the payer's text), nothing saved until the draft is complete, and the real details put back afterwards. An appeal draft counts toward your plan's monthly limit like any other draft.

The result has the same three sections as a packet, so editing and PDF export work the same way.

Review, send and record

1. Edit the appeal and check it against the chart.
2. Send it to the payer yourself.
3. Choose Mark appeal submitted, with the payer reference and date if you have them. This locks the appeal exactly as it is, and you can then download it as a PDF.
4. When the payer answers, record the decision the same way as before.

Second and later rounds

If the appeal is denied or partly approved again, start another appeal. Each round is a new version: the locked earlier appeals are kept, never overwritten, and the new draft takes the previous appeal into account along with the latest reason and the notes you have added since.