AppealIQ generates research-grade appeal letters and prior authorization requests for specialty clinics — citing the payer's own policy, clinical trials, and your patient's exact severity scores. Built by a physician. Reviewed by a physician. Delivered in 24 hours.
Insurance companies now use AI to auto-deny claims at scale. One payer's algorithm denied 300,000 claims in two months at 1.2 seconds per denial — without opening a single patient file.
Most practices don't fight back. Only 11.5% of denied Medicare Advantage requests are ever appealed. The rest is revenue written off — money that belonged to your practice.
AppealIQ fights back with clinical intelligence. Every letter cites the payer's own coverage policy, includes disease-specific severity scores, and references the exact clinical trials that support the treatment. This is what overturns denials.
Your billing team fills out a secure Google Form with the patient's clinical data, denial details, and payer information. Takes 5-8 minutes — less than a phone hold with the insurer.
AppealIQ's engine cross-references 70+ payer-specific coverage policies, 42 clinical trials, 10 state PA laws, and your patient's exact severity scores to build a dual-audience letter that addresses every denial criterion.
The letter is reviewed by a licensed physician, exported as PDF or Word document with your clinic letterhead, and delivered within 24 hours (4 hours for urgent cases).
70+ drug-payer coverage policy entries. The letter automatically cites the payer's own clinical bulletin and addresses each approval criterion individually.
When AI-generated denials are detected, AppealIQ injects specific lawsuit citations — including UHC's nH Predict (90% error rate) and Cigna's PXDX system — demanding human physician review.
Before you submit, see the estimated overturn probability based on payer + drug + denial type. Uses your practice's outcome data and industry benchmarks from AMA and KFF research.
Paste a raw chart note. AppealIQ extracts severity scores, ICD-10 codes, prior treatments, labs, and imaging findings — structured exactly as the appeal letter needs them.
Paste or upload the denial letter. AppealIQ auto-extracts: payer name, denial reason, CARC/RARC codes, appeal deadline, and classifies the denial type. No manual data entry.
Auto-calculates appeal deadlines based on payer and plan type. Warns at 30, 14, and 7 days. Flags tight windows — UHC provider appeals can run as short as 65 days, while ERISA self-funded plans allow at least 180; Medicare Advantage = 60 days. Never miss a deadline.
Track overturn rates by payer, drug, and specialty. See response times. Monitor PA expirations. Identify which payers deny most — and build the case for Gold Card exemption.
Zero PHI storage architecture. Hash-chained immutable audit logs. Auto-generated compliance reports for HIPAA audits. Built to exceed the proposed 2026 HIPAA Security Rule updates.
Medical billing companies can integrate AppealIQ into their workflow via REST API. Submit cases programmatically, track outcomes, white-label ready.
AppealIQ was built by Dr. Muhammad Aftab, MD — a physician who understands that "DAS28-CRP 5.4" means more to a medical director than "the patient has active disease." Every letter reads like it was written by a specialist, because it was designed by one.
Aetna CPB 0655 requires DAS28 >3.2 for adalimumab. UHC may require >5.1. AppealIQ knows the difference and cites the specific policy. Generic appeal tools don't know which threshold your payer uses.
Patient data is processed in memory and never written to a database. When the letter is generated, PHI exists only in your browser. If our servers were breached tomorrow, there would be nothing to steal. No other tool can say this.
Every letter closes with three escalating pressure points: (1) Clinical harm to the patient if denied, (2) Demand for peer-to-peer with a specialty-matched reviewer per 45 CFR §147.136, (3) Legal escalation path (ERISA §502(a), IRO, or state insurance commissioner).
Dear Appeals Department,
I am writing to appeal the denial of Humira for my patient. The patient has rheumatoid arthritis and has not responded adequately to prior treatments. I believe this medication is medically necessary and may benefit the patient.
Please reconsider this decision.
❌ No severity score with number
❌ No payer policy citation
❌ No specific prior treatment details
❌ Hedge language ("may benefit")
❌ No legal escalation
Mrs. Johnson's DAS28-CRP of 5.8 places her in high disease activity per the 2022 ACR/EULAR classification, exceeding your CPB 0655 threshold of 3.2.
Methotrexate 20mg weekly (Jan-Jul 2025, 6 months): DAS28 remained 5.4 with GI intolerance. Adalimumab is indicated per SELECT-COMPARE (ACR50: 45% vs 29%, p<0.001).
We formally demand peer-to-peer review with a board-certified rheumatologist per 45 CFR §147.136.
✅ DAS28-CRP = 5.8 (specific number)
✅ Aetna CPB 0655 cited directly
✅ Drug, dose, duration, failure quantified
✅ Clinical trial with endpoint cited
✅ Legal escalation included
| Capability | AppealIQ | Generic AI Tools | Appeal Lawyer | Hire PA Staff |
|---|---|---|---|---|
| Payer-specific policy citations | ● | ○ | ● | ○ |
| Specialty severity score thresholds | ● | ○ | ○ | ◑ |
| Clinical trial citations | ● | ○ | ○ | ○ |
| AI denial detection + lawsuit citations | ● | ○ | ◑ | ○ |
| State PA law auto-injection (10 states) | ● | ○ | ◑ | ○ |
| Turnaround time | 24 hrs | Minutes | 1-2 weeks | 1-2 hrs |
| Physician review | ● | ○ | ○ | ○ |
| HIPAA compliant | ● | ◑ | ● | ● |
| Monthly cost | < 1 denial | $29-99/mo | $500-2K/letter | $3,750-4,500 |
We're currently onboarding our first pilot clinics in Iowa. This space will feature real outcomes, overturn rates, and physician testimonials from our beta program.
Join the pilot and be featured here →A single overturned biologic denial recovers $3,000-$12,000 in revenue. AppealIQ costs less than that — every month. For our pilot program, access is completely free for 30 days.
We're onboarding a small number of specialty clinics in Iowa for our founding pilot. Full platform access. Physician-reviewed letters. All we ask is honest feedback on quality.