Stop Losing to Denials. Win with Precision.

Professionally written appeal letter templates with built-in compliance citations and formatting — so your team can fight back confidently and get claims paid.

❗ Why Most Appeals Fail

Even with a valid claim, the appeal often goes wrong:

  • Staff use outdated or vague templates
  • Key compliance citations are missing
  • Payer-specific requirements are ignored
  • Clinical details are underdeveloped
  • Teams waste time reinventing the wheel

You only get one shot at a successful appeal. The Core Set gives your team a winning starting point.

✅ When to Choose the Core Set

You need Appeal Shield™ – Core Set if:

  • You’re fighting common denials (CO16, CO97, CO50, etc.)
  • You don’t have a library of pre-written templates
  • You want professionally formatted letters with compliance references
  • You want to save time and improve overturn rates
  • You’re not ready for payer-specific or specialty-specific customization yet

🧾 What’s Inside Appeal Shield™ – Core Set

📝 Top 25 Appeal Letters
Professionally written, plug-and-play templates for the most common denial types, including:

  • CO16 – Missing Information
  • CO197 – No Authorization
  • CO50 – Not Medically Necessary
  • PR96 – Provider Type/Level
  • CO109 – Not Covered by this Payer

Each letter includes:
✔ Editable Word format
✔ Compliance-based language (LCD/NCD references when applicable)
✔ [Insert] placeholders for quick customization
✔ Action-oriented tone for stronger impact

📑 Portal Summary Snippets

Streamlined versions of each appeal letter formatted for use in payer portals with character limits.

📘 Appeal Documentation Reference Guide

Checklist for what to attach with each appeal type to support faster and more successful resolutions.

📌 Formatting & Submission Tips

Best practices for portal entry, fax, or mailed appeal letters — including timing, tone, and escalation pointers.

📌 Formatting & Submission Tips

Use this when mailing or faxing to ensure proper routing and documentation.

🧠 Who This Is For

  • RCM leaders standardizing appeal workflows
  • Billing staff who waste time rewriting letters
  • Small clinics without legal/compliance teams
  • Consultants looking for ready-to-use formats
  • Practices transitioning from reactive to proactive denial management

Win Denials Without Starting From Scratch.

This is best for Staff who need ready-to-use appeal letters by denial type.

🛡️ Appeal Shield™ – Core Set
$349

✅ 25 editable templates + payer summary formats
✅ Best for experienced teams with tracking already in place

Includes 25 most common denial appeal letters + portal summaries + formatting guide + cover sheet.

📈 Results You Can Expect

✔ Faster appeal turnaround times
✔ Higher overturn rates
✔ Less staff time rewriting and reworking
✔ Cleaner, compliance-cited documentation
✔ Improved team confidence
✔ Better internal standardization of appeal practices

🗨️ “These letters made it simple to escalate and cite the right CMS guidance. Game changer.”

Wendy T.

RCM Consultant

FAQ

Yes — each letter comes in editable Word format with placeholder text for patient info, CPT codes, and DOS.

Not in the Core Set. For payer-specific templates and policies, see our upcoming Payer Packs™.

The Core Set is designed for professional (physician) claims, not facility claims.

Medicaid requirements vary by state and are not included in this set. For custom Medicaid packets, contact us.