# Appealing a prior authorization denial

Source: https://priorauth.getgenko.com/guides/appealing-a-prior-authorization-denial · Updated 2026-10-18

A denial is not always the end. Many denials are about missing information or how the case was described, and a well-targeted appeal can address exactly that. These are the general steps; the denial letter and the payer's appeal instructions are the authority for your case.

## Steps

1. **Read the denial letter closely.** Note the stated reason, the criteria it cites and, importantly, the appeal deadline and where to send an appeal.
2. **Decide what the gap is.** Missing document, unmet criterion, a coding mismatch, or a disagreement about medical necessity each need a different response.
3. **Gather what answers it.** New notes, imaging, measurements or outcome scores that speak to the cited reason.
4. **Write to the reason.** Address the payer's stated rationale point by point, and refer to the original request rather than repeating it.
5. **Have the clinician review it.** The clinician who knows the case should confirm every clinical statement.
6. **Send it through the channel the payer specifies, before the deadline,** and keep a record of what was sent and when.
7. **Track the response,** and know the next level of review if the first appeal is not successful.

## Levels of review

Payers typically offer an internal appeal first. Some also offer a clinician-to-clinician conversation about the decision. Where an internal appeal does not succeed, many plans allow review by an independent external reviewer; whether and how depends on the plan and the state. Ask the payer which options apply and what the time limits are.

> Watch the deadline
>
> Appeal windows are limited and are set by the payer and the plan. The date in the denial letter is the one to work to.

## What makes an appeal stronger

- It answers the specific reason given, not the case in general.
- It adds evidence that was not in the first request.
- It is concise, and every claim traces to the record.
- It is signed off by a clinician and sent on time.

## Appeals in Genko Prior Auth

When a decision is recorded as denied or partly approved, Prior Auth drafts an appeal from the original packet, the stated reason and any new notes you add. The draft is reviewed, edited and locked by your team before it goes out, and each round is kept as its own version. See [Appeals](https://priorauth.getgenko.com/docs/appeals) and [Submission and outcomes](https://priorauth.getgenko.com/docs/submission-and-outcomes).

## Related

- [What is prior authorization?](https://priorauth.getgenko.com/guides/what-is-prior-authorization)
- [What goes in a prior authorization packet](https://priorauth.getgenko.com/guides/prior-authorization-packet-checklist)
- [Prior authorization for aesthetics practices](https://priorauth.getgenko.com/specialties/aesthetics)