FAQ
Answers to the questions offices ask
Short answers. Tap a question to open it.
What is an appeal packet?
A ready-to-sign set: a letter that answers the plan's stated reason, a criteria table, an exhibit list, a deadline sheet and a sign-off page.
Who signs it and sends it?
Your physician reviews and signs. Your staff send it. We never contact plans or patients.
Do you need patient information?
Not today. Your staff pick the plan type, the plan's reason and the service. Patient details are filled in your own system. Before we ever accept patient information, both sides sign a business associate agreement.
Which denials do you cover?
Spine and pain first: epidurals, facet procedures, spine surgery, and spine MRI or CT. New types get added when an office brings them.
How fast do we get a packet?
We aim for 2 business days. If we can't build one, we tell you the same business day.
Will the plan approve it?
No one can promise a plan's decision. The packet answers the plan's stated reason with your chart and the rule the plan must follow.
Where do the rules come from?
Public Medicare rules for Medicare Advantage, and the plan's own published policy for Texas plans. See Sources.
What does it cost?
See the founding offer on the home page. Month to month, and you can stop any time.
What if we stop, or you stop?
If you stop, the plan runs to the end of the paid month. If we stop, you get at least 30 days' notice and a refund for anything not delivered. See If we stop.
Do you work with billing firms?
Yes. Firms start with a short pilot. E-mail us for the firm plan.
Who decides what is sent?
Your physician and your office. Provly Appeals is not a substitute for the advice of an attorney.