Part of the file did not finish downloading, so the document reader is missing. Nothing you upload would be read correctly, so the tool is locked until you get a complete copy.
What to do
1. Close this tab.
2. Download the tool again from the shared link, all the way through.
3. Check the saved file is about 9 MB. If it is much smaller, the download was cut short.
4. Open the saved file from your own folder, not from a preview window.
How this works
You prepare the packet and the draft rationale. The Medical Director reviews and makes the determination.
Pick the case type on the home screen.
Type four things: appeal number, member ID, date of service, and enrollee age. The procedure code is fixed for this case type.
Upload the documents into the amber boxes. They turn green once something is in.
Set the ordering provider's network status. That choice decides which rationale template is drafted.
Build Prep, then Download Word or Download PDF.
The rationale is a draft for Medical Director review. Purple-tinted fields were filled by the tool from your documents; click into one and back out to confirm it.
Nursing Appeal Prep Builder
Medical MA Appeals · Case assembly for Medical Director review
· build
Select a category
Pick the line of business this appeal belongs to. Each category holds its own prep templates.
Select a case type
Each tile is a prep template built for one kind of appeal. More will be added as they are approved.
Step 1 · Start here
The procedure code is fixed for this case type. Date of service and age fill the rationale, so both are required.
Step 2 · Upload these documents (drop, paste, or browse)
Appellant letter
Denial notice
Medical records (including the lab report)
Step 3 · Documents
Only if it came in separately
The appellant letter is usually part of the medical records fax. If it is, leave this empty and upload it with the records. Add it here only when it arrives on its own.
Drop, paste, or click to add the denial notice
PDF, image, or pasted screenshot
Drop, paste, or click to add medical records
PDF, image, or pasted screenshot — multi-file, multi-page
Files named with MR (MR1, MR 2, MR_3…) keep that number. Every page is included; the tool does not filter or judge relevance.
Scanned and faxed records are images. Type the ordering provider once — it is remembered and offered on later cases.
Step 4 · Header / Demographics
This lab is out of network on every case of this type. It does not select the rationale.
Typed once, then offered as you type on later cases. It is not on the EOB.
I. Appeal Issue
II. Original Denial
Draft Rationale generated
The rationale is drafted from these values and the ordering provider's network status. It is a draft for Medical Director review, not a determination.
The two dates above build the Chronology of Care and fix the date of admission — the point at which §110.2 asks the criteria to be met.
Step 2 · Appellant letter
Drop, paste, or click to add the facility’s appeal letter
The letter arguing the admission was appropriate. It goes in the packet under Appeal Issue so the Medical Director can see the facility’s case — and it is deliberately kept out of the criteria evidence, because a letter reciting the criteria is not documentation that they were met.
Step 3 · Denial Letter (NDMC)
Drop, paste, or click to add the NDMC
Notice of Denial of Medical Coverage — PDF or image
Step 4 · Records
Drop, paste, or click to add records
Add as many files as you need — uploading again adds to the list
Step 5 · CMS Coverage Guidance
Sign-off
Fill Step 1, upload the documents, then press Build Prep ▸.
