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Get Started

Please answer the following questions and we'll guide you through the next steps.

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Step 1 of 1

Who are you starting this appeal for?

We will tailor the next questions based on your role.

Select your role *

Patient Biller Provider

Is your plan through a government, church, or school group?

This affects which appeal pathway applies.

Government employee *

Yes No

Which insurance company denied or underpaid the claim?

Insurance company *

Other *

What type of provider was involved?

Provider type *

Other *

Do you know the network status for this provider?

Network status *

In network Out of network Not sure

When was the service or denial, and how much was denied?

You can find this on your Explanation of Benefits (EOB).

Date of service or denial *

Denied amount *

Use the denied amount listed on your EOB.

Are you still seeing this provider?

Still seeing this provider *

Yes No

Where should we send updates?

Full name *

Email *

Is the member part of a government, church, or school plan?

Government employee *

Yes No

What type of provider are you billing for?

Provider type *

Other *

Which insurance company denied or underpaid the claim?

Insurance company *

Other *

What was the network status for the claim?

Network status *

In network Out of network

What amount was denied and is this part of multiple denials?

Denied amount *

Multiple denials involved *

Yes No

Who should we coordinate with?

Full name *

Company or practice *

Email *

What is your primary practice field?

Practice field *

Other *

Which state is the practice located in?

Practice state *

Which insurance company denied or underpaid the claim?

Insurance company *

Other *

What was the network status for the claim?

Network status *

In network Out of network

What amount was denied and is this part of multiple denials?

Denied amount *

Multiple denials involved *

Yes No

Who should we coordinate with?

Full name *

Company or practice *

Email *

Review & Confirm

Confirm the details below before submitting.

We will use this information to prepare your appeal. You can go back to edit any answer.

Congratulations on taking the first step toward challenging your denial.

We have received your intake details and will reach out shortly with next steps.

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