Private by design — your data stays on your device. Each tool runs entirely in your browser; the case details you enter are processed locally and are never sent back over the internet, uploaded, or saved to any server. The one exception: tools that offer an AI option use your company’s Copilot for assistance when you choose it. Otherwise, you are the only one who ever sees what you type.
A pre-check that audits a case for overturn risk before it forwards to the IRE (C2C). It reads the plan's EOC — dental, supplemental, and medical — and flags issues that could get the denial overturned, so you can catch them first. Audit only; it does not create a determination.
Assembles a medical Medicare Advantage appeal packet for Medical Director review — lab/genomic testing and post-acute (IRF) admission cases. It reads the denial notice and the medical records, auto-fills the header, flags what is missing, and exports a Word or PDF packet with every attached page text-searchable. It prepares the case; the Medical Director makes the determination.
Preps hospital readmission appeals under Policy R002 (Medicare Advantage & Commercial) for Medical Director review. It walks the nurse through the policy's own two-step review logic and applies it to the findings you supply. Includes an AI option — you paste the Copilot reply back and it parses it; no PHI is transmitted.
The full administrative-appeal workflow in one pass: case intake, EOC analysis, documentation, and IRE packet assembly. It screens grievance vs. appeal, runs the cost-share math (MOOP, deductible, copay), and auto-populates a draft packet. Includes an AI option that reads the documents for you.
Assembles the documentation packet for an administrative denial going to the Independent Review Entity (IRE). Pick the denial type and it generates a tailored checklist of what the packet needs — and why — plus an editable cover-sheet rationale to copy. Covers dental and medical admin denials.
Builds the denial rationale for TENS / electrical stimulator lead (A4595) DME appeals from an out-of-network vendor. Enter the case details and check which denial reasons apply — chiropractor order, TENS for chronic low back pain, no continued-use evidence, proof-of-delivery gaps — and it generates the full rationale to copy.
Guided determination tool for PCR panel unbundling appeals — urine, wound, and fungal/bacterial panels. It screens whether it's a simple unbundling case, then walks you through panel type and MAC jurisdiction to generate the uphold rationale with the right LCA/NCCI language. Templates are editable per jurisdiction.
Assembles a dental Medicare Advantage appeal for Dental Director review. Enter the appeal number, member ID, and codes, load the EOC, and upload the documents — it auto-fills what it can and flags anything missing, then exports an editable Word or PDF prep. It prepares the case; it does not make the determination.