Governed Appeal Pack

An appeal that refuses to make things up

Paste the denial. Every fact in the letter resolves to a confirmed field or a verbatim quote from your document — or it goes on a gap list. Nothing is invented.

How your text is handled. This assembler is deterministic — the text you paste is sealed and matched on the Health Agent server to build the letter; it is not sent to any AI model. Use de-identified text where you can. (The separate photo-intake feature sends images to a cloud AI provider; it is not used on this page.)

1 · Appeal track

Which appeal does this denial fall under? This sets the governing rule and the filing window — both fixed, verified citations.

Appeal type

2 · The denial letter

Paste the denial letter (de-identified where possible). The quotes you enter below must appear verbatim in this text, or they fail closed to the gap list — that is the cite-or-abstain guarantee, not a setting.

Denial letter text — the sealed source

3 · Facts quoted from the denial

Enter each as the exact words from the denial letter above. If a quote isn't found verbatim in the text, it won't be written — it will appear on the "needs from you" list.

Claim number — verbatim quote

Date of service — verbatim quote

Denial reason — verbatim quote

4 · Confirmed patient header

Copied exactly into the letter from your confirmed client record. Leave blank what you can't confirm — blanks are flagged, never guessed.

Patient full name

Patient date of birth

Member / subscriber ID

Insurance company

Free account required — that's your design-partner login. Not legal advice.