A strong appeal letter can recover 30-50% of denied claims. Follow this proven structure:
1. Header Essentials
✔ Patient name, DOB, ID #
✔ Claim #, Date of Service
✔ Payer name, denial reason code
2. Appeal Structure
Paragraph 1: State purpose + cite policy (quote payer’s rule if misapplied)
“We appeal the denial of CPT 99214 for patient X on [date], per your policy [quote policy #] which states…”
Paragraph 2: Attach evidence:
- Medical records (highlight relevant sections)
- NCCI/LCD policy proof (if applicable)
- Prior auth documentation
Paragraph 3: Clear request + deadline
“Please reprocess this claim within 30 days to [corrected payment amount].”
3. Pro Tips
✔ Be concise (1 page max)
✔ Use bold/underline for key points
✔ Send certified mail + keep copies
