Generic First-Level Appeal Letter

Use this as the default first-level reconsideration when the denial doesn't match a specific template. Keep it tight: name the denial, state why it's wrong, attach the proof, and ask for a specific outcome.

What makes it win

• Identify the claim, the denial code, and the exact reason precisely
• State the single clear basis for reconsideration — coverage met, coding correct, data now supplied
• Attach the one or two documents that carry the argument, and list them
• Ask for a specific outcome (reprocess and pay) and give a contact for questions

The template

Replace the [BRACKETED] fields with your details. This is the manual version of the appeal Volari files for you automatically.

[PRACTICE LETTERHEAD]
[DATE]

[PAYER NAME] — Appeals Department
[PAYER APPEALS ADDRESS]

RE: First-Level Appeal / Request for Reconsideration
Patient: [PATIENT NAME]   Member ID: [MEMBER ID]
Claim #: [CLAIM NUMBER]   Date(s) of Service: [DOS]
CPT/HCPCS: [CPT CODE]   Denial code: [CARC/RARC]

To the Appeals Department:

We are requesting reconsideration of the above claim, denied on [DENIAL DATE] as [DENIAL REASON / CARC]. We believe the denial is incorrect for the following reason.

[STATE THE ONE CLEAR BASIS: the service met the plan's coverage criteria / the correct code and diagnosis are documented / the required information is now enclosed / the payer's records were inaccurate.] The enclosed documentation supports payment: [DESCRIBE SUPPORT — office note, coverage policy, clearinghouse report, corrected claim].

The service was [performed / documented / medically necessary] as billed, and nothing in the record supports the denial.

We respectfully request the claim be reprocessed and paid. Please contact [CONTACT NAME] at [PHONE] or [EMAIL] with any questions, and confirm the outcome of this appeal in writing.

Enclosed: [list of documents].

Sincerely,
[PROVIDER / BILLING MANAGER NAME], [TITLE]
[PRACTICE NAME] — NPI [NPI]   TIN [TIN]

Common questions

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