Peer-to-peer review: how to request one and how to win it
The physician-to-physician call that can overturn a clinical denial before a formal appeal.
Read the guideEscalationExternal review (IRO): the independent appeal after the plan says no
The binding independent review after internal appeals are exhausted.
Read the guideMedicareThe five levels of Medicare appeals
From MAC redetermination to federal court — the full Medicare appeal ladder.
Read the guideMedicaidMedicaid fair hearings: the beneficiary's appeal right
The federally guaranteed beneficiary appeal for Medicaid denials.
Read the guideOut-of-networkNo Surprises Act: open negotiation and federal IDR
Open negotiation and federal arbitration for surprise out-of-network bills.
Read the guideUrgentExpedited and urgent appeals: the fast track
The fast-track appeal when waiting would jeopardize the patient's health.
Read the guideWorkflowCorrected claim vs. appeal: which one does your denial need?
The decision rule that stops you from appealing what you should have corrected.
Read the guideDocumentationProof of timely filing: the documents that win a CO-29
The acceptance trail that overturns a timely-filing denial.
Read the guideDocumentationHow to structure a medical-necessity appeal letter
The structure that maps the record to the payer's own coverage criteria.
Read the guidePlan typesERISA appeals: the rules for employer self-funded plans
Self-funded employer plans run on federal ERISA rules — not state insurance law.
Read the guideOut-of-networkSurprise medical bills: your No Surprises Act protections
When you can't be balance-billed — and how to dispute a bill that breaks the rules.
Read the guidePost-payment reviewRetroactive denial: appealing a clawback or a rescission
When a claim is reversed after it was paid — or coverage is canceled after the fact — and how to push back.
Read the guideKnow the process. Let Merits write the letter.
Upload a denied EOB and Merits builds the appeal for the level it belongs at — cited to the rule that governs it, and timed to your plan's deadline.