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For your staff

Check five things before you ask for a packet

About five minutes, in your own system. Patient details stay with you. Our form asks for three picks only: plan type, the plan's reason and the service.

1. The denial notice

  • Plan type.
  • The plan's reason, as written.
  • The appeal deadline, in your calendar.
  • Where to send it: fax, portal or mail.

2. The service

  • Which one: epidural, facet procedure, spine surgery, or spine MRI or CT.
  • Before care or after care.
  • Level and side.

3. The chart

  • How long the pain has lasted.
  • Care already tried, and for how long.
  • The imaging report.
  • A pain or function score from before the procedure.

4. The signer

  • The treating physician (MD or DO) can sign before the deadline.
  • Your letterhead and the physician's NPI are on file with us.

5. Sending it out

  • Who sends it, and how.
  • Where you keep the sent copy and the receipt.

Missing something? Ask for the packet anyway. Its exhibit list shows what to attach before the physician signs. Print this page for your front desk.