Claim Intake
By answering the following questions about your denial we'll help you determine your best path of recovery, whether that's an appeal or a required negotiation IDR process.
Your progress is saved locally so you can continue if you refresh.
Who are you starting this claim for?
We will tailor the next questions based on your role.
What type of dispute is this?
Select the high-level request type so we can route your intake correctly.
What type of dispute is this?
Select the high-level request type so we can route your intake correctly.
Is your plan through a government, church, or school group?
This affects which appeal pathway applies.
Which insurance company denied or underpaid the claim?
What type of provider was involved?
Do you know the network status for this provider?
About how much was denied?
Providing an approximate range allows us to assess timing and eligibility while avoiding the collection of sensitive claim details at this stage.
Did you receive this denial in the last 30 days?
Where should we contact you?
What is the provider practice or business name?
What is the provider's primary practice field?
What is the provider's primary practice field?
What state is the provider practice located in?
Optional business location qualifier.
Which insurance company is involved?
What is the network status for this dispute?
Is this related to a government, church, or school plan?
Optional high-level qualifier.
Are multiple denials or underpayments involved?
Optional high-level qualifier for intake routing.
Approximate billed amount range
Select the general range of billed charges related to this dispute.
Did you receive this denial or underpayment in the last 30 days?
Who should we coordinate with?
What is your primary practice field?
What is your primary practice field?
Which state is the practice located in?
Which insurance company denied or underpaid the claim?
What was the network status for the claim?
Are multiple denials or underpayments involved?
Optional high-level qualifier for intake routing.
Approximate billed amount range
Select the general range of billed charges related to this dispute.
Did you receive this denial or underpayment in the last 30 days?
Who should we coordinate with?
Review & Confirm
Confirm the details below before submitting.
We will use this information to understand your appeal situation. You can go back to edit any answer.