Five steps. The tool fills in what it can; you check it and hand the prep to the Dental Director.
Type three things at the top: appeal number, member ID, and the codes being appealed.
Load the EOC. The contract number is read from the file name, and Section IV builds itself from it.
Upload the documents into the amber boxes. They turn green once something is in. The denial notice fills in the header automatically.
Press Build Prep. Anything still blank gets highlighted so nothing is missed.
Download Word (editable) or Download PDF. You will be asked to confirm you checked the auto-filled values. For PDF, choose Save as PDF as the destination in the dialog that opens.
Purple-tinted fields were filled by the tool from your documents. Click into one and back out to confirm it. This prep is for director review and contains no determination.
RDH Clinical Prep Builder
Dental Medicare Advantage Appeals · Case assembly for Dental Director review
· build
Step 1 · Start here — confirm these three before building
Appeal Number and Member ID never come from the notice (the ID prints masked), so type those. Procedures are auto-filled when the notice carries a code table — check them. Everything below is pulled from the documents or remembered from your last case.
One line per procedure code (with the quadrant/teeth and quantity for that code). Drives the whole EOC lookup: frequency, criteria, and Limitations & Exclusions pages. Verify against the notice even when auto-filled.
Step 3 · Upload these documents (drop, paste, or browse)
EOC (plan Evidence of Coverage)
Appellant letter
Denial notice
HRP claim history — only for frequency, benefit limitation, or annual max reached denials
Medical records
Step 2 · Load the EOC auto-extract
Click to load the plan EOC (PDF)
The tool reads printed page numbers, the Schedule of Benefits grid, and the Limitations & Exclusions criteria directly from this file. Nothing leaves your computer.
Step 4 · Header / Demographics
I. Appeal Issue
Codes being appealed are entered in the box at the top of this panel.
Drop, paste, or click to add the appellant letter
PDF, image, or pasted screenshot
II. Case Summary
III. Original Denial
Drop, paste, or click to add the denial notice / EOB
PDF, image, or pasted screenshot
IV. Guidelines auto from EOC
Load the EOC and enter the appealed code(s), then press Build Prep to auto-populate this section.
V. Claim Review
Optional — these two values power the frequency-window and benefit used/remaining math in the Case at a Glance box. Pull them from the HRP claim history above.
Drop, paste, or click to add the claims screenshot
PDF, image, or pasted screenshot
VI. Clinical Review
Drop, paste, or click to add the MR-records outreach screenshot
PDF, image, or pasted screenshot
Fills a denial-type outline to complete (you write the clinical facts — the tool never argues the case).
Drop, paste, or click to add clinical records
PDF, image, or pasted screenshot — multi-file, multi-page
Files named with MR (MR1, MR 2, MR_3…) keep that number. Anything else is numbered in the order added. Every page of every file is included — the tool does not filter or judge relevance.
Sign-off
Fill the case fields, load the EOC, and press Build Prep ▸. The assembled prep appears here and prints clean to PDF.
