Every claim checks out — tap it, read the source.
A reviewer can dispute an opinion. They can't dispute their own policy, quoted word for word. In your letter, each underlined claim opens the exact passage it rests on.
From your appeal letter
[PATIENT NAME] has chronic migraine with new focal neurologic features. . And as a non-grandfathered ACA plan, .
Tap an underlined claim — its source appears →
…reserved for the patient whose presentation indicates a focal problem or who has experienced a significant change in symptomatology.
Why this was cited — Medicare coverage criteria for CPT 70553, cited as persuasive evidence of the standard of care.
You know the treatment was necessary. Proving it to the payer is the part that eats your evening.
What's missing isn't the medicine. It's the reviewer's language, the payer's own policy, and an hour you don't have — and Merits brings all three.
Denials keep getting faster and more automated. Appealing them one letter at a time, by hand, can't keep pace — and the clinical call always stays yours.
When you bill the claims
The clinical argument is the one you can't write alone.
Without Merits
It bounces to the physician for a support letter — and sits for days.
With Merits
Built and cited for you. The physician just reviews and signs — minutes, not from scratch.
When you're in the room
Denials pile up faster than the evenings to fight them.
Without Merits
So they go in the drawer — and the appeal window quietly expires there.
With Merits
The translation's done in about a minute. Whether the care was right stays your call.
The simplest way to fight a denial — on purpose.
Every other option is a subscription, an integration, or a cut of your collections. Merits is a $25 letter when you need one, and nothing the rest of the time. That isn't a missing feature — it's the whole idea.
Pay only when you appeal
No subscription, no per-seat fees, no annual contract. $25 is one letter. A quiet month costs you nothing.
Nothing to install or integrate
It's a web page — no IT project, no clearinghouse hookup, no onboarding call. Open it, paste the denial, done.
Your patient's identity stays on your device
Merits strips the patient's name, member ID, and date of birth in your browser before anything is sent — the AI never sees who the patient is. Your device fills them back into the finished letter at download, and Merits deletes your EOB once it's ready.
Your appeals, kept for you
Start with no signup. We email you a private link to every appeal you've run and your credit balance — so it's all there when you come back. Add a password anytime to make it a full account.
From a denial to a letter you can sign.
You upload the EOB. Merits turns a flat denial code into a cited argument and a submission-ready packet — you review, sign, and send. About a minute of work.
$631
written off — for now
01
The denial
A flat reason code and a write-off you don't have time to fight.
Each claim matched to the payer's own rules — and the law.
- Coverage policyLCD L37373
- Federal regulation45 CFR §147.136
- Coding editNCCI
Every source quoted verbatim
02
The evidence
Every claim tied to a verbatim source you can open and check.
Ready to sign
+ checklist · where to file
03
Sign & send
A cited letter, an attachment checklist, and where to file it.
A submission package, not just a letter.
Most of the work of an appeal isn't the writing — it's knowing what to attach and where to send it. Merits hands you all three.
The appeal letter
Formal, cited, and structured the way payers expect — ready for your signature.
Enclosures
- Office notes
- Exam
- Prior imaging
An attachment checklist
Exactly which records and proofs to include, named for this denial.
Submit to
Anthem — Appeals
Provider portal
File by
Oct 7, 2026
Where to submit it
The right channel for your payer — portal, Availity, or fax — and the file-by date.
Why not a general AI, or your own afternoon?
Each alternative is genuinely good at something. Here's the honest catch with each — and what Merits keeps from all of them.
A general AI
AlternativeFast — but it invents citations.
It'll confidently cite a regulation or case that doesn't exist — on a letter you sign — and you've pasted the patient's data into a general chatbot.
Doing it by hand
AlternativeRigorous — but it eats your afternoon.
An hour or more per appeal to find the policy, draft it, and assemble the packet — which is why roughly two of three denials never get appealed.
Denial software
AlternativePowerful — but it's a real commitment.
A subscription, a contract, and an integration to stand up — overkill for a solo practice, and your patients' data lives in their platform.
The full picture
| Merits | By hand | A general AI | An appeals service | |
|---|---|---|---|---|
| Time to a finished letter | About a minute | Hours | Minutes | Days to weeks |
| What it costs | $25 flat | “Free” — $43–118 of staff time | ~$20/mo + your time | % of recovery, or $100+ each |
| Citations quoted verbatim from primary sources | Yes — closed corpus | Only if you dig them up | Often fabricated | Varies by vendor |
| Risk of an invented or wrong citation | Blocked by validators | Human error | High — hallucination | Low — a person checks |
| Tailored to your exact code, plan & payer policy | Yes | If you're the expert | Generic | Yes |
| Tells you when not to appeal, before you pay | Yes — up front | Your judgment | It won't | Rarely — paid to pursue |
| Patient identity stays on your device | Yes — stripped in-browser | — | No — you paste PHI | No — you share records |
| You review, sign & stay in control | Yes — you sign | Yes | Yes | No — they act for you |
| Human judgment beyond the written record | Limited to its sources | Yours | Generic | A specialist’s |
Hand-appeal cost: MGMA / industry ($43 to process a denial, $64–118 to appeal). Service pricing varies — many bill a share of recovered dollars, with denial management one line item among many. The last row is the honest one: Merits doesn't replace a person's judgment — it removes the time and the citation risk that stop most appeals from ever being written.
- Every citation quoted verbatim and checked
- Honest when a denial isn't worth it
- The full packet — checklist, channel, deadline
- Read in your browser; no data sent to us
- $25 a letter — nothing to commit to
Trust earned by mechanism, not by adjective.
Every appeal leans on one closed corpus of primary law and policy — real documents, captured word-for-word. Never a source we can't show you.
- 13
- federal appeal-rights texts, captured verbatim
- 1,200+
- Medicare coverage policies, re-synced weekly
- 1.7M
- coding-rule edits — ICD-10, NCCI & HCPCS
- 0
- invented citations — the closed corpus won't allow one
How a source becomes a citation
Captured verbatimmatched to your exact denialquoted, then re-checked against the source.
A dead source drops from the pool automatically; anything unsupported is flagged for your review, never stated as fact. AI-assisted drafting — you review, sign, and submit under your own name. Merits gives no legal or medical advice and guarantees no outcome.
Is it even worth appealing? We'll tell you straight.
Two honest answers before you spend a cent: whether your denial code is the kind worth fighting, and whether the money on the line clears the cost. No upsell — including when the answer is “don't bother.”
1 · Is this denial appealable?
Why was your claim denied?
Not medically necessary
The payer doesn't deem the service medically necessary.
Worth appealing. Roughly 4 to 5 of every 10 appealed denials get paid — and this is one Merits builds a cited case for.
The appeal deadline depends on your plan — Merits calculates yours exactly.
2 · Is the money worth it?
Run the math on your denial
Drag it, or type the exact amount the payer is holding back.
At stake
$420
With Merits
$25
By hand
$25–117
Clear math
$420 on the table for $25 — about $17 of exposure for every dollar you spend. The amount in dispute dwarfs the $25 to file. This is the kind of denial that's expensive to leave on the table.
Appeals are overturned roughly 4 to 5 times out of 10— yet fewer than 1 in 100 are ever filed. Merits doesn't change whether you're right; it removes the two things that stop the letter from getting written: the time, and the risk of a wrong citation.
Overturn rate: KFF ACA marketplace analysis, 2024, and NY DFS external-appeal data, 2025 (34–53% depending on plan and state). Hand-rework cost: MGMA ($25 median, higher for complex appeals). Odds vary by plan, payer, and documentation — never guaranteed.
And there's a clock. Every denied EOB has an appeal window — usually 60 to 180 days — and once it closes, the money is gone for good. Merits reads your plan type and gives you the exact date.
Pay per use. No subscription, no contract.
$25 is about what it costs a practice to rework one denied claim by hand — except Merits does the work, and cites every line of it.
Credits never expire · no subscription · no auto-renew
We'll tell you before you pay if a denial is rarely worth appealing, or if the amount in dispute is small — your call, made with the facts.
Most denied claims are never appealed. More than half that are, get paid.
What stops most appeals isn't whether you can win — it's the time, and the risk of a wrong or invented citation on a letter you put your name to. Merits returns it in about a minute, every source quoted verbatim and checked. For $25.