Answer an insurance denial with the criterion it failed
A denial usually means one specific thing was missing or weak: conservative treatment not documented, a code that does not match, a severity with nothing to back it. Rewriting the whole letter in better prose does not fix that. ClearPass reads the denial, names the criterion that failed, and rewrites the justification to answer it.
How it works
- Paste the rejected note and the denial reason, or the denial code, with the service that was refused.
- Read the diagnosis. ClearPass states why it was most likely rejected and how the rewrite addresses it. If the answer needs a fact only you know, it asks a few targeted questions first.
- Resubmit. Choose a Targeted Fix, which rewrites the justification and codes for the refused items only, or a Full Rewrite with a fresh note. Anything that needs action outside the letter, such as a test not yet done, is listed.
The usual reasons a request is refused
Denial wording varies, but most refusals fall into a handful of groups. Knowing which group yours is in tells you what the answer must contain.
| Stated reason | What the answer needs |
|---|---|
| Not medically necessary | The criteria the service must meet, each matched to a finding or date in the chart |
| Insufficient documentation | The missing piece itself: a report, a therapy log, a score, a treatment date |
| Conservative treatment not tried | What was tried, for how long, and why it failed or could not be used |
| Code mismatch or invalid code | A corrected diagnosis or procedure code that supports the service |
| Experimental or not covered | Usually a policy question; the letter can state the clinical case but cannot change coverage terms |
Each of these has its own page: not medically necessary, missing documentation and coding errors.
What a good resubmission looks like
It opens by naming the service and the stated reason for refusal, then answers that reason directly with facts from the chart. It does not repeat the original letter at greater length, argue with the reviewer or add emotional language. Where the original request left out something that was in fact done, the resubmission says so with dates.
Re: Refused request for adalimumab, stated reason: prior systemic therapy not documented. [Patient initials] has plaque psoriasis (L40.0) with a body surface area of 14% and a quality of life index of 16 at today's review. Prior systemic therapy, omitted from the first request: methotrexate, titrated to 15 mg weekly, taken for 5 months and stopped because of a sustained rise in liver enzymes to more than three times the upper limit of normal on two occasions. Phototherapy was not possible because of work shift patterns and travel distance, documented at the visit when it was offered. The request therefore meets the prior-therapy requirement and is resubmitted for review.
How payer rules are used
Where we hold your country's rules pack, the failed criterion is quoted from your payer's rules. Where we do not, it is reasoned clinically, and no payer, scheme or rule number is invented.
Clinicians and their staff who handle refused prior authorization requests are the people this is built for. The same tool writes the first letter, so the next request can go in complete.
What ClearPass does not do
- It does not replace your judgement. Every note is an AI draft that you review and correct before it is used.
- It is not a medical device and does not make clinical decisions. It is a documentation aid.
- It does not connect to your EMR. The note is copy-ready text that pastes into any system.
- It does not file the appeal. You review the rewrite and resubmit it yourself.
- It does not promise the decision will change. It answers the stated reason as well as the clinical facts allow.
- It does not write a legal brief. The resubmission reads as a clinical letter.
Privacy
Clinical note content is not stored on ClearPass servers: it is processed to write the note, then discarded. Consultation audio is transcribed and discarded, never stored. Your note history stays in your browser, on your device, and you choose how long it is kept. Common identifiers are removed from typed and transcribed text before it reaches the AI; that is a best-effort safeguard, so leave names, ID numbers and file numbers out where you can. Processing goes through the AI providers named in our Privacy Policy, which sets out exactly what each one receives and how long it keeps it. ClearPass does not sign HIPAA business associate agreements today.
Questions
What do I need to paste?
The rejected note or letter, the denial reason or code, and the service that was refused. If you do not have the old note, it asks targeted questions to rebuild the case.
Will it re-justify everything in the original request?
No. A Targeted Fix defends only the items that were refused, and accounts for each of them.
Does it work with any insurer?
Yes. Where we hold your country's rules pack it quotes the payer's criteria; elsewhere it argues the clinical case without citing any rule.
When should I choose Full Rewrite instead of Targeted Fix?
When the original note was thin throughout, or the refusal questions the diagnosis itself. A Full Rewrite produces a fresh note and justification; a Targeted Fix keeps what was accepted and fixes only what was refused.
What does ClearPass cost?
The 7-day trial is free, needs no card and simply ends after 7 days, with no automatic charge. After that there is one plan: $78 a month or $858 a year, with every visit transcribed.
Try it on your next clinic day
The full product for 7 days, with no card and no automatic charge. Then $78 a month or $858 a year. Pricing details.
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