Generate Medicare-compliant, policy-backed appeals in minutes—so your team recovers more revenue without guessing what to cite.
Three steps. No blank pages. No guessing which policy to cite.
Pull in patient details, skilled services, denial reason, and discharge risk. Clean structured intake — no chart-chasing required.
The system maps clinical facts to Medicare coverage standards and pulls the right supporting policy. Every appeal is automatically mapped to CMS policy and case law—so your team doesn’t have to guess what supports coverage.
Your team edits the appeal, adds physician review if needed, and exports a clean PDF. Nothing is submitted without your approval.
Built for the workflows your team already runs
Structured, policy-backed, and traceable. Built from the same logic your best appeal reviewer uses.
This letter requests reinstatement of Medicare Part A SNF coverage for the beneficiary, whose skilled nursing and therapy services were terminated effective 04/12/2026.
Patient continues to require skilled PT at 5x/week for gait training and functional mobility. Section GG scores indicate Mod Assist level. Fall risk: HIGH.
Medicare Benefit Policy Manual, Ch. 8, §30.2.2 — daily skilled services requirement. Jimmo v. Sebelius — maintenance therapy coverage when skilled care is required.
Elevated safety risk: 3 falls in 14 days, incomplete ADL independence, no 24-hour caregiver at planned discharge destination.
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.
SNFs and consultants managing appeals regularly.
Custom implementation for large operators.
Not generic writing. Purpose-built for the compliance, speed, and traceability your team needs.
Every appeal follows a clean, reviewer-friendly structure that matches what QIOs expect.
Pulls the right CMS and Jimmo support for each case. No guessing which regulation applies.
Built around BFCC-QIO deadlines. Same-day turnaround for close-of-business submissions.
Your team stays in control. Edit, approve, then export. Nothing submitted without sign-off.
Clean, professional output your staff can actually send. No reformatting needed.
Reduce variability across staff and locations. Same quality, every appeal.
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.
PHI protection is foundational. Data is encrypted in transit and at rest. We do not use patient data to train models.
Every section is fully editable. Change wording, add clinical details, adjust policy citations — then export as a clean PDF.
Give your team a faster, more consistent way to build policy-backed appeals.
No hype. No black box. Just a stronger starting point for every appeal.