Denials should return with a path, not a pile of rework.
AuthQuire reads the denial, finds the missing evidence, drafts the appeal letter, and prepares a peer-to-peer brief — all inside the same reviewable workspace.
- Denial reason parsed and tied to payer policy
- Appeal letter drafted with source citations
- Peer-to-peer brief prepared for the treating clinician
- Denial
- Gap
- Draft
- P2P
- Review
Read the denial as three things: code, requirement, gap.
Non-covered services because this is not deemed a "medical necessity" by the payer.
Payer policy requires six weeks of supervised PT in the prior 12 months.
Submission did not include the dated note range. Source is on file and ready to cite.
Source-cited draft, editable section by section.
We respectfully request reconsideration of the above determination. The member completed six weeks of supervised physical therapy (02-04 → 03-15) with persistent radicular symptoms, as documented in the attached PT notes. Imaging on 03-14 demonstrates L4–L5 disc protrusion consistent with the clinical presentation, satisfying payer policy PA-217.4.
- Clinical summaryDrafted
- Conservative therapyDrafted
- Imaging findingsDrafted
- Policy citationDrafted
- Closing & signatureAwaiting reviewer
The clinician walks into the call with a brief, not a stack.
- 02-04PT initiated, 2x weekly
- 02-25Home exercise program added
- 03-15PT discharge — persistent symptoms
- 03-18Specialist evaluation
- Anchor on completed conservative care (six weeks).
- Tie imaging to the requested CPT under policy PA-217.4.
- State the functional impact in ROM values, not adjectives.
Appeal letters, peer-to-peer briefs, and supporting evidence are assembled inside the queue. Nothing leaves your workspace until a named reviewer — and, where required, the treating clinician — signs off.