Appeal letter generator
Pick the denial code and your state. You get a letter that quotes the code’s own standard description, makes the argument that answers that code, and — where the date has passed — cites your state’s statutory payment deadline. Free, no sign-up, and nothing you type leaves your browser.
Your letter
September 12, 2026
[Payer name]
Provider Appeals
[Address from the remittance or the payer portal]
Re: Appeal of denied claim [Claim number]
Provider: [Your practice name]
Denial code: CO-197 — Prior authorization absent
To whom it may concern,
We are appealing the denial of the claim referenced above. The remittance advice reports CO-197, whose standard description is: "Precertification/authorization/notification/pre-treatment absent."
Our record shows the authorization requirement for this service was met. We are attaching the authorization and asking you to match it to the claim on code, units, date range and rendering provider.
Please reprocess this claim for payment. If you maintain the denial, please provide a written explanation identifying the specific plan provision or policy relied on, so that we can respond to it directly.
Attached:
• A copy of the claim as submitted
• The remittance advice showing this denial
• The documentation described above
Please direct any questions to the contact below.
Sincerely,
[Name]
[Your practice name]
[Telephone] · [Email]Before you send it — the checks that decide whether this lands
These come from the page on this code, and they are the difference between an appeal and a request to be denied twice. Work them first; attach what they produce.
- Pull the authorization record and compare four things against the claim: the CPT code, the units, the date range and the rendering provider
- If a valid authorization exists and simply was not transmitted, correct the claim and resubmit rather than appealing
- If the authorization covers a different code, check whether the payer allows a retro-authorization and how many days you have — the window is often as short as 72 hours after service
- If it was genuinely never obtained, file a retro-authorization request with the clinical documentation showing medical necessity, and expect to lose some of these
- Log the reference number and the name of the person who confirmed it, every time
What this code means in plain words: The payer required prior authorization for this service and cannot find one attached to the claim. The full page on CO-197, including how to stop it recurring.
Why most appeals get denied twice
The commonest appeal in American healthcare is a paragraph asking the payer to “please review the attached claim”. It is not an appeal. It identifies no error, answers no code and asks for nothing specific, so the cheapest thing the payer can do is uphold the denial — and that is what happens.
What moves a claim is narrower and duller: the payer’s own claim number so the letter can be matched to the file; the denial code in the payer’s own standard wording so there is no argument about what was said; one paragraph answering that specific code rather than denials in general; and a request for a written reason if the denial stands, because a written reason either resolves the claim or becomes the record for the complaint that follows. All four are public information. Almost nobody assembles them, because assembling them takes twenty minutes and there are forty more denials in the queue.
What this does not do
- It does not quote a deadline for a state whose rule is not a day count. Missouri counts “processing days”, a defined term, and Washington sets a monthly volume standard rather than a per-claim deadline. Both would produce a confident wrong date, and a practice that escalates on a wrong date loses the argument and some standing with it.
- It does not apply state prompt-pay law to Medicare, Medicaid or self-funded ERISA plans, because it does not apply to them. Leave the receipt date blank for those.
- It does not know your claim. The argument paragraph is the right shape for the code; the facts in it are yours to confirm before you send it.
- It does not store anything, so it cannot show you a history. That is the trade, and on a page about denied claims it is the right way round.
Questions
How do I write an appeal letter for a denied medical claim?
An appeal that moves a payer has four parts: the claim identified by the payer’s own number, the denial code quoted in the payer’s own standard wording, the specific argument that answers that particular code, and a request for a written reason if the denial stands. A letter asking the payer to "please review" has none of those and is usually denied a second time. This tool assembles all four from the code you pick and the state you are in.
Is this appeal letter generator really free?
Yes, and there is no sign-up, no email wall and no account. The letter is assembled in your own browser: nothing you type is transmitted to us or to anyone else, and nothing is stored. You can read the page source and confirm it.
Can I put the patient’s name in it?
Do not. The form deliberately does not ask for a patient name, date of birth, member ID or date of service, and you should not type one in. Copy the letter to your own machine and add the patient identifiers there, inside your own system.
What is the prompt-pay paragraph, and when does it appear?
Most states set a statutory deadline for paying a clean claim — commonly 30 calendar days electronic and 40 to 45 on paper. If you give the date the payer received the clean claim and that deadline has passed, the letter states the deadline, the date it passed and the statutory citation. If the state’s rule is not a day count, or the deadline has not passed, the paragraph is left out rather than guessed at.
Will this work for Medicare or Medicaid denials?
The code and the argument will. The prompt-pay paragraph will not: Medicare and Medicaid run on their own payment rules rather than the state statute, so leave the receipt date blank for those and use the appeals process the programme publishes.
Is this legal advice?
No. It is a drafting tool. Every factual sentence in the letter is either the denial code’s standard description, your state’s statutory deadline with its citation, or something you typed. Read it before you send it, and take advice on anything that turns into a dispute.
That letter took twenty minutes. So does the next one.
The letter is the easy part — the checks above it are the appeal, and there are forty more denials behind this one. Send ninety days of aged AR and you get back, in writing, which of them are recoverable and what working them would take. Free, whether or not you buy anything.
Nothing you typed into the tool above is attached to this. This form sends the three fields in it and which page it came from — that is all it can send. Or write to ops@softhomeglobal.com and skip the form entirely. What happens to it.
Next step
If the queue is longer than the hours
This letter takes twenty minutes. So does the next one. A seat works that queue full time, on your hours, inside your own system — and you can see the work before you pay for it.
Or write to ops@softhomeglobal.com