Try ResolveRCM on a real denial — free for 7 days See a Real Appeal Packet →
Built for billers, RCM managers, and practice ops teams handling denials. Not templates. Not copy-paste. Built from your inputs every time.
Exactly what gets submitted to payers — no signup
ResolveRCM provides documentation assistance and does not guarantee payer outcomes.
FORMAL APPEAL REQUEST
To: BCBS Medical Review
Re: Reconsideration/Appeal for CPT 63030-LT on [DOS]
Patient: [PATIENT_NAME] (no PHI)
Rendering Specialty: Pain Management
Treating Provider: [PROVIDER_NAME]
Member ID/Claim #: [CLAIM_NUMBER]
Dear Medical Review Committee,
We are writing to formally appeal the denial of CPT 63030-LT for the above-referenced patient. The procedure was performed on [DOS] and was medically necessary based on the following clinical rationale...
Sample content with redacted patient information. All data shown is fictional.
What's Included
Appeal Letter
MDM Sheet
Coding Validation
Attachments Checklist
Download Your Appeal Package
Word Document
Editable .docx file
Single PDF
All sections in one file
Important: ResolveRCM does not submit claims or integrate directly with EHRs.
Works alongside your existing systems—no integration required
Enter denial details, claim context, and clinical information
Select payer, specialty, and service
Generate a complete appeal packet (letter + MDM summary + checklist)
Export and submit through your existing billing workflow
Each packet includes:
ResolveRCM does not submit claims or integrate directly with EHRs.
Generate professional documentation for every denial scenario
Generate a complete appeal packet for a denied claim, including an appeal or reconsideration letter, structured supporting documentation, and export-ready files for submission.
Create MDM-style clinical narratives that clearly summarize medical necessity, prior treatment, and clinical decision-making—designed to support appeal review.
Turn denial and remark codes into a focused checklist of what to address and include—helping you build more complete packets without guesswork.
ResolveRCM is an EHR-agnostic tool library that helps billing and clinical teams generate complete appeal packets—including appeal letters, MDM-style medical necessity summaries, and supporting documentation checklists—so you can submit stronger, more consistent appeals.
127
Total Appeals
78%
Success Rate
14 days
Avg. Resolution
Appeal Outcomes
By Payer
No new workflows to learn. Just better appeals, faster.
See a Real Appeal Packet →Sample Medical Group
1234 Medical Center Dr, Suite 200
Ph: (555) 123-4567 | Fax: (555) 123-4568
FORMAL APPEAL REQUEST
RE: Claim #BCB-2024-789456 | DOS: 11/15/2024
Dear Medical Director,
We respectfully submit this formal appeal regarding the denial of claim BCB-2024-789456 for CPT code 64483 (lumbar epidural injection). The denial cites "medical necessity not established," however, the documentation clearly supports...
Clinical Rationale: Patient presented with L4-L5 radiculopathy with documented failed conservative treatment including 6 weeks of physical therapy and...
All screenshots and examples shown use fictional data for demonstration purposes only.
Each packet includes a structured appeal letter paired with a clear documentation framework—so reviewers can quickly understand the case you're making.
ResolveRCM organizes clinical details into a concise, defensible medical necessity summary that supports your appeal without rewriting charts.
Medical Decision Making (MDM) Support
Problems Addressed:
Chronic lumbar radiculopathy with documented nerve root compression at L4-L5. Failed conservative treatment documented including 6 weeks PT, NSAIDs, and activity modification.
MDM Level: Moderate
Data Reviewed and Analyzed:
MRI lumbar spine (11/01/2024) showing L4-L5 disc herniation with neural foraminal narrowing. Prior PT records reviewed. EMG study confirming radiculopathy.
MDM Level: Moderate
Risk of Management:
Prescription drug management with potential for adverse effects. Interventional procedure with moderate sedation and fluoroscopic guidance.
MDM Level: High
Overall MDM Level Supported: Moderate
Two of three elements support Moderate level per AMA E/M guidelines.
All screenshots and examples shown use fictional data for demonstration purposes only.
Packet Ready for Download
Your complete appeal packet has been generated and is ready to export.
Packet Contents:
All screenshots and examples shown use fictional data for demonstration purposes only.
Export packets as Word or PDF files and submit them using your existing payer portals, clearinghouse processes, or EHR workflows.
ResolveRCM is designed for billing offices of any size. Share a simple invite code with your team members and get everyone onboarded in minutes—no per-seat pricing, no user limits.
Simple Invite Codes
Share an 8-character code—team members join your organization instantly
Role-Based Permissions
Owner, Manager, and Member roles with appropriate access levels
Centralized Billing
One subscription for your entire organization—packet-based, not per-seat
Sarah Johnson
sarah@practice.com
Mike Chen
mike@practice.com
Amy Rodriguez
amy@practice.com
AB3X7K9P
Monitor your appeal outcomes, identify trends by payer, and measure your success rate over time
See your appeal win rate at a glance. Track outcomes over time and identify what's working.
Break down performance by payer. Know which insurers approve more and where to focus efforts.
Download your analytics data for reporting, compliance, or deeper analysis in your own tools.
ResolveRCM is built with privacy and security principles appropriate for healthcare documentation workflows, with controls aligned to industry standards.
Protected Health Information is stored only in your browser's local storage—never transmitted to our servers or the AI.
Automatic detection warns you if patient names, dates, or identifiers appear in text before sending to the AI.
Team permissions ensure the right people have access to the right features.
All data encrypted in transit and at rest using industry-standard protocols.
Comprehensive audit trails for compliance and accountability.
Security controls designed around SOC 2 trust principles.
Full access to all features. No credit card required to get started.
Generate consistent, complete appeal packets—without EHR integration or workflow disruption.
7 days free. No credit card required.