Get help with your cases

1. Take the 5-step tour. It takes 2 minutes.

Take the tour

1. WISeR resubmission: Original Medicare did not affirm a WISeR request. You send it again with the same tracking number (UTN).
2. Texas plan appeal: A Texas fully insured plan said no. This is your first appeal to the plan.
3. Specialty review request: A Texas plan said no to your appeal. You ask for a reviewer in the same or a similar specialty.
4. Medicare Advantage reconsideration, before care: A Medicare Advantage plan said no before care. Your physician asks the plan to look again.
5. Peer-to-peer brief only: The plan offers a call with its reviewer. You get a one-page brief for your physician to use on the call.
6. Employer plan appeal (self-funded): A self-funded employer plan said no. The patient names your practice as their representative, then you appeal.
7. Medicare claim appeal (redetermination or QIC): Original Medicare denied a claim after care. First you ask for a redetermination; if that fails, the QIC.
8. Medicare Advantage claim appeal (out-of-network office): A Medicare Advantage plan denied payment, and your office is not in its network. You sign the plan's waiver form and appeal.
9. Outside review (IRO or federal): The plan said no on its last appeal. An independent reviewer looks at the case, by the route the plan's letter names.

What we make for each kind of plan

1. Look at the front of the patient's ID card. TDI or DOI there means a Texas fully insured plan.
2. Not sure? Call the number on the back of the card and ask: is this plan fully insured or self-funded?

1. As soon as it is built, usually within a minute. Open the case: it says "Ready for you".
2. Anything our automatic checks flag is listed on the packet's cover for your physician.

1. Open the case and download the draft.
2. Fill each [square bracket] blank from your own records, outside this site.
3. Never type patient details here, and never e-mail them to us.

1. Your staff tick the 4 paperwork boxes.
2. Your physician reads the packet and confirms it.
3. Download it, fill in the blanks, and your physician signs it.
4. Your staff send it to the plan. We never send anything.
5. When the plan decides, open the case and tell us what it decided.

1. Start a new case for the next step, such as a specialty review for a Texas plan.
2. "What we make" shows the next steps we cover for each kind of plan.

What we make

1. Your physician can change answers on the case page and make the packet again.
2. Each change makes a new version, and your staff check it again.

1. Only your practice manager can. Go to Team, pick their role and make an invite link.
2. Send the link to them yourself. It works one time, for 7 days.

1. Ask your practice manager to remove your name and send you a new invite link.
2. If the practice manager is locked out, they contact us.

1. Open the sign and press Ctrl+P (Cmd+P on a Mac).

Open the sign