Appeal letters · see how it works
Citation-grounded Medicare appeals
Describe the denial. CLV Intelligence finds the policies in its database that govern it and drafts an appeal letter that quotes their exact language — every quotation verified against the official CMS document before you see it. No policy on file for the denial means no letter, not a guess.
Medicare and Medicare Advantage
Under 42 CFR 422.101(b), a Medicare Advantage plan must follow CMS national coverage determinations and the written coverage decisions of the local Medicare contractor — so the same LCD/NCD governs an MA denial. Letters are written for the right appeal either way: a redetermination to your MAC (120 days), or a reconsideration to the plan (60 days).
Why this isn’t a chatbot
Most AI tools let a model writethe policy language — and it invents quotations CMS never used, in quotation marks, attributed to a named LCD. This one can’t, by design: the model may only copy passages verbatim from the official CMS document, and every quote is checked character-for-characteragainst that document before the letter is generated. A quote that isn’t in the source is rejected and the letter is never shown. The policy id, source link, and version are slotted in by the system — never written by a model.
1 · Describe the denial
- Procedure codes
- 0565T, 0566T
- Specialty
- Orthopedics
- Cited policy
- LCD L39128
- MAC region
- Palmetto GBA
No PHI — just the codes, the cited policy, and the region. The full tool accepts any denial and finds the governing policy for you.
2 · Get a redetermination letter
Re: Request for redetermination — 0565T, 0566T
To the Palmetto GBA Redetermination Unit,
We request redetermination of the denial of the above services. The enclosed documentation establishes that the criteria of the governing coverage policy were met, and the denial is inconsistent with that policy:
The exact coverage language from LCD L39128 — copied verbatim from the CMS document and validated character-for-character — is inserted here.LCD L39128 · CMS Medicare Coverage Database ↗ · version-dated
Accordingly, we ask that the denial be reversed and the claim reprocessed for payment. Supporting records are enclosed.
An illustration of the letter’s structure. The verbatim CMS passage and its citation are inserted by the generator from the real document — never written by a model. The policy id and source link above are real: open them and check.