ResolveRCM Walkthrough

Enter the Denial Details

You start by selecting the payer (for example, UnitedHealthcare, Aetna, or a Medicare Administrative Contractor), the denial reason code (such as CO-97 for bundling or CO-4 for missing modifier), and the medical specialty (cardiology, orthopedics, primary care, and more). ResolveRCM uses these inputs to apply the correct payer-specific appeal logic and regulatory language before any content is generated.

Add De-identified Clinical Facts

You enter the clinical facts that support medical necessity — things like the patient's presenting symptoms, relevant diagnoses and ICD-10 codes, procedures performed and CPT codes, and supporting clinical rationale. No patient name, date of birth, MRN, or other Protected Health Information is entered here. ResolveRCM's Privacy by Design architecture keeps PHI entirely in your browser and never transmits it to the AI or our servers. What you type in this step is de-identified clinical context only.

ResolveRCM Generates the Appeal Packet

In under four minutes, the AI produces a complete, multi-document appeal packet that includes:

• Appeal letter — a professionally worded letter addressed to the payer's appeals department, citing clinical rationale, applicable guidelines, and the specific reason the denial should be overturned.
• MDM support summary — a structured Medical Decision Making (MDM) document that organizes the problems addressed, data reviewed, and risk level to substantiate the complexity of the encounter for E&M coding defense.
• Documentation summary — a concise narrative that ties the clinical documentation to the billed codes, making it easier for the reviewer to see the connection between the visit and the charges.

You can see examples of each document on the sample appeal packet page.

Review and Merge Patient Information

The generated content uses placeholder tokens — for example [PATIENT_NAME] and [DATE_OF_SERVICE] — wherever PHI belongs. In the review step, you enter (or confirm from local storage) the actual patient details. The merge happens entirely in your browser: ResolveRCM substitutes the placeholders with real PHI client-side and the populated document is never sent back to the server. This is how your billing team can use AI assistance while remaining HIPAA-conscious.

Export and Submit to the Payer

With one click, download the finished packet as a DOCX file (editable in Microsoft Word or Google Docs) or a print-ready PDF. The appeal letter, MDM summary, and documentation summary are each formatted as a standalone document, ready to attach to a payer portal submission or fax. ResolveRCM also records the appeal in your dashboard so you can track status, log outcomes, and analyze denial trends over time.

Browse the appeal template library to see the payer-specific and specialty-specific language ResolveRCM uses, or review pricing to find the plan that fits your team's volume.