The filing flow
Start an appeal
From a denial’s detail view, click Start appeal. The strategy recommendation is pre-selected; you can change it.
Review the draft
Within ~60 seconds, the AI drafts the appeal letter with pulled medical records, policy citations, and clinical rationale. You see a side-by-side view with the original denial.
Edit if needed
Rich-text editor for the letter body. Any edits you make are tracked and fed back into learning — this is how the drafting gets tuned to your practice’s voice.
Attach supporting docs
Upload or pull in operative reports, chart notes, medical necessity letters, and any payer-specific forms. PHI-encrypted, audit-logged.
Sign
Route to DocuSeal. The provider signs electronically. Or, if your practice permits, a staff member signs on behalf of the provider with a stored delegation.
What goes into the draft
Appeal rights language
Appeal rights language
Pulled from the denial letter — always cited with the exact source language and date the denial was received.
Medical necessity argument (if applicable)
Medical necessity argument (if applicable)
Built from the patient’s chart notes, diagnoses, and procedure history. The AI pulls only the relevant records — we don’t dump the chart.
Policy / regulatory citations
Policy / regulatory citations
Plan-specific language when we have it, plus state and federal citations (ERISA, ACA, state insurance codes).
Peer-reviewed literature (where appropriate)
Peer-reviewed literature (where appropriate)
For medical necessity appeals, we pull 2–3 peer-reviewed sources supporting the clinical rationale.
Provider voice
Provider voice
Over time, drafts are tuned to match your practice’s tone based on your past edits.
Signing
DocuSeal e-signature
Provider receives an email, reviews the letter, signs. Signature is audit-logged and embedded in the PDF with a tamper-evident hash.
Delegated signing
Practice admins can grant specific staff the authority to sign on behalf of a provider. Every delegated signature is audit-logged with the delegator, delegate, and time-scope.
Submission channels
| Channel | When to use | What we do |
|---|---|---|
| Payer portal | When the payer requires portal submission | Direct upload (where API available) or guided manual upload checklist |
| Fax | Payers with fax-only appeals | HIPAA-compliant fax via integrated provider; confirmation stored |
| Certified mail | When the payer’s policy requires it | Label generated; tracking number captured into the appeal record |
| In-person courier | Rare — specific payers | Documented in insurer guide if applicable |
After submission
Receipt captured
Confirmation number, portal timestamp, fax transmit receipt, or mail tracking number — whatever the channel provides.
Deadline tracker
The payer’s response window is computed and displayed. You’ll get reminders at the 14-, 7-, and 1-day marks.
Quality gates
- No appeal can be submitted without a generated PDF.
- No appeal can be submitted without a valid signature (provider or delegated).
- Appeals for denials with a deadline < 24 hours require a second confirmation.
- Audit log records every draft edit, signature, and submission.
Limitations
We don't file appeals automatically
We don't file appeals automatically
Every appeal requires explicit human approval and signature. We are not — by design — an autonomous claims bot.
We don't guarantee overturn
We don't guarantee overturn
The strategy recommendation includes an overturn probability, but outcomes depend on the specifics of each case and payer. You stay in charge of what to file.
We don't replace your provider's clinical judgment
We don't replace your provider's clinical judgment
For medical necessity appeals, the provider must review the clinical rationale before signing.