What types of denials can Sarva appeal?

Sarva generates appeals for coding-related denials, medical necessity disputes, modifier denials, and authorization-related denials where the clinical documentation supports the service. It does not generate appeals for denials where the documentation is genuinely insufficient.

How long does it take to generate an appeal letter?

Sarva generates a draft appeal letter in under 60 seconds after retrieving the clinical documentation and claim data. Staff review and approval typically takes 3–5 minutes, compared to 30–60 minutes for manual letter writing.

Use Case

Denial Appeal Automation with AI-Generated Appeal Letters

Denial appeal automation uses AI to generate payer-specific appeal letters that cite the relevant clinical documentation, coding guidelines, and payer policy provisions that support claim payment. Sarva reads the denial reason, analyzes the encounter documentation, and drafts a structured appeal letter — reducing appeal preparation from hours of manual writing to minutes of review.

Automate Your Appeal Workflow

The Business Problem

Appealing denials is the highest-value, lowest-completed activity in revenue cycle. Each appealable denial represents recoverable revenue, but writing a compelling appeal letter requires clinical knowledge, coding expertise, and payer policy familiarity. Most practices appeal only a fraction of appealable denials because the manual effort is prohibitive. Appeal turnaround of 2–3 weeks means claims age further during the appeal process.

Affected Team

Denials specialists, coding staff, and revenue cycle leadership. The financial impact falls on the CFO and practice owners who lose revenue from unappealed denials.

How It Works

Current Manual Workflow

A denials specialist reads the denial reason, reviews the encounter documentation, searches for relevant coding guidelines and payer policies, and manually writes an appeal letter. Each letter takes 30–60 minutes. The specialist must tailor the argument to the specific payer and denial reason. Letters are mailed or uploaded to payer portals, and tracking is manual.

Automated Workflow with Sarva

Sarva reads the denial reason code and remark codes, retrieves the encounter documentation and claim data, and generates a structured appeal letter that cites the specific clinical evidence, coding guidelines, and payer policy provisions that support payment. The letter is drafted in the appropriate format for the destination payer. Staff review, approve, and submit — typically in under 5 minutes per appeal.

Inputs

Denial reason codes and remark codes
Encounter clinical documentation
Claim data (codes, modifiers, charges)
Payer-specific appeal requirements
Relevant coding guidelines (CPT, ICD-10, NCCI)

Outputs

Drafted appeal letter with clinical citations
Payer-specific formatting and submission format
Appeal tracking with status monitoring
Appeal outcome analytics

Human Oversight

Staff review every drafted appeal before submission. Sarva generates the letter, but a human confirms the clinical argument is sound and the documentation supports the claim. This ensures appeals are accurate and compliant while eliminating the writing burden.

Security Considerations

All clinical documentation and claim data is processed in an encrypted, isolated environment. Appeal letters contain PHI and are handled with the same security standards as all Sarva data. HIPAA BAA included. SOC 2 Type II certified.

Integration Considerations

Sarva integrates with your EHR to retrieve clinical documentation and with your practice management system for claim data. Appeal letters can be submitted electronically through payer portals or clearinghouse connections where supported. For payers without electronic appeal submission, letters are generated as PDFs for mailing.

Limitations

Sarva cannot appeal denials where the clinical documentation genuinely does not support the service billed. If the documentation is insufficient, no appeal letter — however well-written — will overturn the denial. The system identifies documentation gaps and flags them for provider education rather than generating unsupported appeals.

Key Performance Indicators

Appeal submission turnaround

Target

< 48 hours

Appeal overturn rate

Target

> 70%

Appeals filed per staff hour

Target

5x increase

Revenue recovered via appeals

Target

Practice-specific

See how this workflow applies to your practice.

Automate Your Appeal Workflow

Related Connectors

Frequently Asked Questions

Sarva drafts appeal letters for staff review. A human reviews and approves each letter before submission. For payers that support electronic appeal submission, Sarva can submit after staff approval. For others, letters are generated as PDFs for portal upload or mailing.

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