Appeal Packet Builder
Turns a health plan denial into a submission-ready appeal packet with deterministic fact extraction and AI-drafted appeal language.
Appeal Packet Builder
When a health plan denies a claim, the employer’s benefits team has 180 days and a stack of PDFs. We built the tooling that turns a denial letter into a submission-ready appeal packet — cover sheet, structured appeal letter with plan citations, supporting exhibits, and a full audit trail.
The Problem
Filing a health plan appeal means assembling a coherent argument from scattered source documents: the EOB, clinical notes, the plan’s summary of benefits, maybe a prior authorization letter. Most benefits teams don’t have the clinical vocabulary or the regulatory knowledge to do this efficiently. The ones that try spend hours manually cross-referencing PDFs. The ones that don’t leave money on the table.
How It Works
The system extracts structured facts from EOBs, clinical notes, and plan documents using deterministic parsing — no LLM guesswork on codes, dates, or dollar amounts. Diagnosis codes, procedure codes, denial reasons, plan exclusions, and appeal deadlines are pulled with precision and verified against source.
AI drafts the appeal language from cited plan provisions and clinical evidence. Humans review before anything ships. The output is a complete appeal packet: cover sheet, structured appeal letter, supporting exhibits indexed and labeled, ready for submission.
Every extraction, analysis, and generation event is logged immutably. If a reviewer asks “where did this number come from,” the system can trace it back to the source document, page, and line.
Key Capabilities
- Deterministic document parsing — extracts codes, dates, dollar amounts, and denial reasons from EOBs, clinical notes, and plan documents without LLM interpretation
- AI-drafted appeal letters — generates appeal language grounded in specific plan citations and clinical evidence
- Complete packet assembly — cover sheet, appeal letter, supporting exhibits, and audit trail in a single output
- Immutable audit logging — every extraction, analysis, and generation event traced back to source
- Human-in-the-loop review — AI drafts, humans approve. No appeal ships without review.
Scope
Built for self-insured employers appealing Premera Blue Cross denials. One carrier, one workflow, one output. Deliberately narrow — depth over breadth.
Status
In active development.