Justified drafts structured, policy-backed Medicare appeals in minutes — every claim traceable to the chart, every argument grounded in CMS policy.
Patient ambulated 50 ft with rolling walker, requiring skilled cueing for L hip precautions1. MDS Section GG scores confirm substantial assist for functional mobility2.
Per MBPM Ch. 8 §30.2.2, a service is skilled when its complexity requires supervision by qualified personnel3. Jimmo clarifies coverage does not turn on improvement potential4.
When Medicare terminates SNF coverage, your team has hours — not days — to assemble a defensible DENC response. Most facilities are doing this with Word templates, copy-pasted policy language, and whatever the case manager can pull together before close of business.
The result? Inconsistent appeals, missed arguments, and revenue that walks out the door.
Your team enters the clinical details — functional status, therapies, denial reason, safety risks. Justified maps every fact to the right CMS policy and generates a complete, structured appeal ready for review.
This isn't about billing optimization. It's about making sure patients get the care they need and facilities get paid for the care they've already provided.
Many coverage terminations happen while patients are still making progress. A strong appeal can keep them in care.
Families don't understand why coverage is ending. A clear, defensible appeal gives them — and the facility — a real chance.
Case managers are handling 15 things at once. Justified takes the hardest one — building the argument — off their plate.
Structured, policy-backed, and traceable. Every claim links back to its source — try clicking a [1].
We request reinstatement of Medicare Part A SNF coverage for Ms. J.R., whose services were scheduled to end 04/15/2026 per NOMNC.
Patient ambulated 50 ft with rolling walker, requiring skilled cueing for L hip precautions1. MDS Section GG scores confirm substantial assist for functional mobility2. Surgical incision shows a 1 cm area of delayed closure requiring ongoing skilled assessment3.
Per MBPM Ch. 8 §30.2.2, a service is skilled when its inherent complexity requires supervision by qualified personnel4. Jimmo clarifies coverage does not turn on improvement potential5.
We respectfully request the QIO overturn this termination and reinstate coverage through completion of the current skilled plan of care.
Based on appeal volume and team size. Start with a sample — no commitment.
Occasional appeals at a single facility.
Per-appeal pricing available
See SampleSNFs and consultants managing appeals regularly.
Monthly subscription by facility
Book DemoCustom implementation for large operators.
Custom pricing
Talk to UsNot a generic AI tool with a healthcare label. Purpose-built for PHI-handling workflows.
All data encrypted in transit and at rest. BAA available. Built to meet healthcare data handling requirements.
Patient data is never used to train models. Your clinical information stays yours.
Control who can create, review, and export appeals. Built for multi-user clinical teams.
Every appeal generation and edit is logged. Full traceability for compliance review.
Every claim in the appeal links back to a chart source. Because the provider bears the burden of proof.
Tracks CMS notice form versions and effective dates. Enforces correct templates as CMS updates them.
No. Justified gives your team a stronger starting point. Your staff still reviews, edits, and approves every appeal before it goes out.
Absolutely. Every appeal is fully editable. Nothing is submitted without your team's explicit review and approval.
We started with expedited DENC appeals because deadlines are tightest. We're expanding to hospital discharge (DND) and medical necessity denials next.
Yes. The system handles both Original Medicare and Medicare Advantage, including the MA-specific requirement to describe changes in condition since a prior favorable appeal.
Justified is HIPAA-compliant with a Business Associate Agreement (BAA) available. Data is encrypted in transit and at rest. We do not use patient data to train models. Full security documentation is provided during onboarding.
Every section is fully editable. Change wording, add clinical details, adjust policy citations — then export as a clean PDF.
When Medicare denies continued SNF coverage, families can submit a support letter alongside the facility's appeal. These letters document what clinical notes often miss — the daily reality of care needs, safety risks, and what discharge would actually mean.
Our free tool helps you write one in minutes. No medical jargon required.
Write a Free Support Letter →See what a Justified appeal looks like for your team — or try the free family tool right now.