ExpertSigned

What do you need?

Select the document type. Each is drafted to the specific requirements of the document and payer.

Prior Authorization Request

Initial PA request to insurance payer — includes clinical justification, CPT/ICD codes, and supporting documentation summary. $35–$45

Insurance Denial Appeal Letter

Formal appeal of a denied PA — addresses the specific denial reason with clinical evidence and payer policy citations. $75–$120

Specialist Referral Summary

Comprehensive patient summary for specialist referral — clinical history, current medications, reason for referral. $50–$80

Medical Necessity Letter

Letter of medical necessity for equipment, procedures, or treatments requiring insurer justification. $45–$70

Practice Information

We use this to format the document on your practice letterhead and route it to the correct reviewer.

Practice Name *

Specialty *

Ordering Physician Name *

Physician NPI Number *

10-digit National Provider Identifier. Required for all PA documents.

Practice State *

Practice Phone *

Practice Fax (for document delivery)

Contact Email *

Completed document will be delivered to this address.

Patient & Clinical Details

All information is encrypted and handled in full HIPAA compliance. Only the assigned reviewer accesses this data.

🔒 This data is AES-256 encrypted at rest, transmitted over TLS 1.3, and deleted 48 hours after document delivery. A signed BAA is available on request.

Patient First Name *

Patient Last Name *

Date of Birth *

Patient Gender

Insurance Company *

Member / Insurance ID *

Group Number

Requested Treatment / Drug / Procedure *

CPT Code(s)

ICD-10 Diagnosis Code(s) *

Clinical Summary / Medical Necessity Justification *

Include: diagnosis history, previous treatments and outcomes, relevant lab values, functional impact on patient.

Urgency

Standard

24 hours

Urgent

12 hours +$25

How would you like to provide information?

You've already filled in the key details. Choose how you'd like to complete the intake.

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Form complete

Proceed with what you've entered

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Phone interview

We call you to confirm & fill gaps

Phone Number *

Preferred Call Language

Best Time to Call

How the call works: Our agent will call at your chosen time, confirm the details you've entered, and ask any clarifying questions needed to complete the document. Typical call: 5–10 minutes.

Additional notes for the reviewer

Review & Submit

Confirm your order details before proceeding to payment.

Order Summary

Document Type—

Practice—

Patient—

Payer—

Turnaround24 hours

Delivery—

Total Due—

Payment

Secure payment processed by Stripe. Card details are never stored on our servers.

Name on Card *

Card Number *

Expiry *

CVV *

🔒 256-bit SSL encryption · Powered by Stripe · PCI DSS compliant

I agree to the Terms of Service and confirm this is a document preparation service, not legal or medical advice.

100% satisfaction guarantee. Free revision within 7 days of delivery.

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Order Received

Your prior authorization document is being prepared. You'll receive a confirmation email shortly, and your completed document within 24 hours.

1Check your email for an order confirmation with your reference number.

2A licensed physician will review your document within the next few hours.

3Your completed document arrives by email within 24 hours, ready to submit.

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Prior Authorization &
Appeal Letters

Order Summary

What you get

Need help?

Order Received

Prior Authorization &Appeal Letters

Order Summary

What you get

Need help?

Order Received

Prior Authorization &
Appeal Letters