For practice managers and billing leads at Texas medical practices

December pilot: appeal packets for denied procedures, surgery and scans, prepared for your physician to sign.

We start with spine and pain: epidurals, facet procedures, spine surgery and spine MRI or CT.

E-mail us about the pilot See how it works

Appeal packet: Medicare Advantage reconsideration request, before careSAMPLE

From: [PRACTICE NAME]
Patient: [PATIENT NAME]
Plan: [PLAN NAME] (Medicare Advantage)
Service appealed: Epidural injection, low back

Blanks in square brackets are filled by the practice, in its own system, before the physician signs.

Criteria table, Medicare rule L36920
Coverage rule	Chart	Exhibit
Pain for at least 4 weeks	Shown	Ex. B
At least 4 weeks of conservative care did not help	Shown	Ex. C
MRI, CT or myelogram matches the history and exam	Shown	Ex. D
A pain or function scale recorded before any injection	Shown	Ex. B

Treating physician signature

Page 2 of 8

A made-up sample page. Every sample page is marked SAMPLE. See the made-up samples

i.The pilot

The December pilot covers four kinds of denial

Spine and pain packets come first. New types get added when an office brings them.

Epidurals
Denied epidural steroid injections.
Facet procedures
Denied facet nerve blocks and nerve ablation.
Spine surgery
Denied back and neck surgery.
Spine MRI or CT
Denied imaging of the spine.

Each packet is prepared for your practice's physician to sign. It holds a letter that answers the plan's stated reason, a criteria table, an exhibit list, a deadline sheet and a sign-off page.

ii.How it works

It works in three steps

Step 1: Your office picks choices
Your staff pick the plan type, the plan's reason and the service from short lists. No patient names, dates or ID numbers.
Step 2: We prepare the packet
Every packet passes our automatic checks, and a person checks every packet those checks flag, plus a random sample.
Step 3: Your office checks, signs and sends
Your staff tick a short checklist, then your physician reviews and signs, then your staff send it.

iii.Our limits

We never contact your plans or patients

We never log in to payer portals or ask for portal passwords.
We never submit, fax or mail anything to a plan.
We never call plans or patients, and we never suggest billing codes.
We never charge a share of what you collect.

iv.Security

Security and leaving, in plain words

Today we accept no patient information

Before we accept any, these will be in place:

A business associate agreement, signed by both sides.
One server in a United States AWS region, encrypted in transit and at rest.
Invite-only accounts with two-step sign-in. Every action is logged.
Not in place yet. No SOC 2 report and no outside penetration test.

Security, item by item

If we stop, you keep your packets

Month to month, with no setup fee and no exit fee.

At least 30 days' notice, by e-mail and phone.
Every open packet finished or handed back.
Your files returned, then erased, with a signed note.
A refund for anything paid and not delivered.

If we stop, step by step

v.The pilot

Early offices can join the December pilot

Founding offer: the first 3 practices to sign get their first month free (up to 20 packets), then $300 a month plus Texas sales tax. Cancel any time.

E-mail us about the pilot