Three documents. Two synthetic cases.
The patients and the practice are invented. The payer policy is a real, public document. Every [C#] marker is a citation to the record — a page of the policy or a line of the chart.
![Page 1 of the PA readiness report for synthetic case #10: readiness summary — 5 of 5 requirements documented — and the criteria assessment with [C1]–[C3] citations](/_next/image?url=%2F_next%2Fstatic%2Fmedia%2Fdoc-readiness-report-p1.3psmrj94dm7qv.png&w=3840&q=90&dpl=dpl_EmutM7DVRLEW7hLzSKR58K5uSKT2)
01 · BEFORE SUBMISSION · CASE #10
Readiness report
The internal record of the pre-submission check. Every criterion in the payer's policy is marked met or not yet shown, with the chart quote beside it and the policy page cited. What isn't shown becomes the gather list.
Stays internal. Kept with the case and never sent to the payer; the review footer prints on every page.
Written deterministically from the criteria check — no free text.
02 · BEFORE SUBMISSION · CASE #10
Letter of medical necessity
Drafted only once the gather list is clear. Each requirement in the policy is answered with the chart's own words, and each sentence carries its citation. The provider reviews and signs.
Payer copy. Letter, codes, enclosures list — no internal notes.
Signed by your provider after the review gate.
![Page 1 of the appeal packet for synthetic case #8: the appeal letter with letterhead, payer address, RE block and [C1] citation markers](/_next/image?url=%2F_next%2Fstatic%2Fmedia%2Fdoc-appeal-packet-p1.14yk7rk81vnlu.png&w=3840&q=90&dpl=dpl_EmutM7DVRLEW7hLzSKR58K5uSKT2)
03 · AFTER A DENIAL · CASE #8
Appeal packet
The appeal letter answering each denial reason with the payer's own policy language; the codes and duration request; the pre-submission checklist; the internal case summary; and a sources list that resolves every marker.
Placeholders in drafts. Anything the record doesn't establish prints as a visible placeholder until staff supply it — the payer copy exports only once every item is resolved.
Two exports. A clean payer copy, and the full internal record.
The payer copy carries no review stamp — a person's approval is the control. The internal record carries the review footer on every page.
Every marker points somewhere you can check.
The sources list at the end of each document quotes the exact passage behind every [C#] — the denial letter, the payer's policy with its page numbers, or the chart note. A reviewer never has to trust a sentence; they can read where it came from.
The verifier flags any quote it cannot find verbatim in the cited source, and the flags travel with the packet until a person resolves or acknowledges them.
![Evidence references from the appeal packet: [C1] the denial letter quoted in full, [C2] the payer policy page 2, [C3] the chart note assessment](/_next/image?url=%2F_next%2Fstatic%2Fmedia%2Fdoc-appeal-packet-p3.0m6rp-vwrx976.png&w=3840&q=90&dpl=dpl_EmutM7DVRLEW7hLzSKR58K5uSKT2)
Want to see one built for your payer?
In a 20-minute walkthrough we run a synthetic case against a policy your practice actually sees.