Templates
Free appeal letter templates
Six letters for the denials that cost practices the most. Each one is structured the way a payer’s appeals reviewer reads: the claim facts up front, one clear argument, a specific request, and a deadline.
Read and copy any of them without signing up. Refer to the patient by initials and account reference only — a template that travels by email is no place for a full name or date of birth.
- CO-197Prior authorization appeal letterFor denials asserting no authorization was on file. Works whether the authorization existed, was never required, or the payer missed its own decision deadline.
- CO-29Timely filing appeal letterFor denials asserting the claim arrived late. Built around proof of the original submission date, which is what actually overturns these.
- CO-50Medical necessity appeal letterFor clinical denials. Structured to argue from the payer's own coverage criteria rather than asserting necessity, which is what distinguishes the appeals that win.
- CO-16Missing information appeal letterFor CO-16 denials where the claim was correct as submitted. Includes the timely-filing protection that matters most on these.
- CO-97Bundled service appeal letterFor denials treating a distinct service as already paid. Argues from documentation of separate work, without straying into coding advice.
- CO-22Coordination of benefits appeal letterFor denials asserting other coverage is primary. Resolves the payer's coordination-of-benefits record, which is usually what is actually wrong.
What separates an appeal that works
- One argument, not four
- Every template offers alternative paragraphs. Keep the one that matches your facts and delete the rest — a letter hedging across every possibility reads as a form letter and gets treated as one.
- Evidence, not assertion
- Reviewers overturn on documents. An acceptance report, an authorization number, or a note mapped to the payer’s own criteria does more than any amount of restating the claim.
- A specific request
- Ask for reprocessing and payment of a stated amount. Asking the payer to “review” invites another denial with no obligation to explain it.
- Sent before the deadline
- The best letter loses to a closed window. Check the appeal deadline on your remittance the day the denial arrives, not the week you get to it.
The templates are free. Filling them in is the slow part.
Undeny reads the denial document, fills every bracketed field from it, and tracks the deadline until the money comes back.