# Write an appeal letter for a denied medical claim

A point-by-point appeal that answers the payer's denial reason with policy criteria and documentation, plus a check on whether a corrected claim is faster.

- Topic: Finance & Accounting
- Framework: RTF
- Level: Advanced
- Tags: Finance, Legal, Write, Analyze, Fill-in Template
- Source: https://www.thinkwithprompt.com/prompts/write-an-appeal-letter-for-a-denied-medical-claim

## Prompt

```text
Help me write an appeal for a claim our clinic had denied.

**Payer and plan type:** [e.g. "commercial PPO", "Medicare Advantage", "Medicaid managed care"]
**Appeal level:** [first-level reconsideration / second level / external review]
**Denial reason and codes:** [CARC/RARC codes and the exact wording on the EOB or remittance]
**Service details:** [date of service, CPT/HCPCS codes, modifiers, ICD-10 codes as billed]
**What the record shows:** [SUMMARY of supporting documentation, provided by our clinical or coding staff]
**Payer policy or contract language:** [PASTE medical policy, LCD/NCD, or contract clause if known]
**Appeal deadline:** [DATE]

First, classify the denial (coding or modifier error, missing information, medical necessity, prior authorization, timely filing, eligibility, bundling) and tell me whether a corrected claim or reopening would resolve it faster than a formal appeal.

Then draft the letter:
1. Header: patient name, member ID, claim number, date of service, billed amount, all as placeholders.
2. One sentence stating exactly what we want reversed.
3. A point-by-point response to the denial reason, quoting each policy criterion and showing where the record meets it.
4. A numbered list of enclosures.
5. A closing that requests a written decision and references our appeal rights.

Rules:
- Use only the facts and codes I give you. Mark anything missing as [CONFIRM]; never invent policy numbers, dates, or clinical details.
- Do not make or change clinical judgments. The clinical argument must come from the documentation and be reviewed by the treating provider.
- Include only the patient information the appeal needs (HIPAA minimum necessary).
- Keep the letter to one page plus enclosures.
```

## What to fill in

- first-level reconsideration / second level / external review
- PASTE medical policy, LCD/NCD, or contract clause if known
- DATE
- CONFIRM

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