Appeals for dermatology practices, built from your chart.
Appeals turn on showing a lesion or condition was medically necessary to treat, not cosmetic, with pathology, symptoms and failed prior treatment. Matches payer rules to the lesion description, pathology result, symptoms and prior treatments in the chart, and flags a missing pathology report or symptom note before the letter goes out.
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What the reviewer looks for.
These are the points a dermatology appeal has to prove. ClaimDoc checks each one against your record and names the page that proves it, or the document that is missing.
Lesion or condition described
The note describes the lesion or condition (site, size, appearance, duration and any change) and the diagnosis made.
Symptoms or pathology that make treatment necessary
The record shows symptoms (for example bleeding, pain, irritation or infection), a concerning change, or a pathology result that make treatment medically necessary rather than cosmetic.
Prior treatment tried, where the payer expects it
Where the treatment follows other therapy, the record shows what was tried, for how long and the result.
Procedure documented
A procedure note records what was done, where, and the number and size of lesions treated.
The records it asks for.
ClaimDoc asks only for what this denial needs, marks what you've uploaded, and says in a line why each one matters.
- Office visit note with the lesion descriptionneededShows the site, size, features and symptoms.
- Pathology reportA biopsy result is often the proof that treatment was necessary.
- Procedure noteneededShows what was done, where and how many lesions.
- Record of prior treatments and responseMany payers expect conventional therapy to have been tried first.
Denials it handles.
Plain words first. For each, what usually decides the appeal.
“Cosmetic, not medically necessary”
Documented symptoms, a concerning change, or a pathology result.
“Procedures billed together”
A separate site, lesion or session, with the right modifier and a note that shows it.
“No prior authorization on file”
The approval and what it covers (for example phototherapy or biologics).
The rules ClaimDoc holds for dermatology.
Stored word for word
No payer policy for this specialty is stored word for word yet. The letter says what the record shows and asks the payer for the criteria it applied.
Medicare coverage on file
35 local and national coverage documents from CMS, across 7 Medicare contractors. When a Medicare denial rests on one, the letter names the one for your contractor and asks which provisions applied.
Payers, by how much is known
- Elevance Health (Anthem)
- Aetna Medicare Advantage
- Alignment Healthcare
- Cigna Medicare Advantage
- Clover Health
- Devoted Health
- Humana
- Original Medicare (Part A outpatient and Part B)
- SCAN Health Plan
Tested, not promised.
Each of these ran from upload to a finished, verified packet on synthetic records, and every factual sentence traced to a page of the record or a stored policy.
- Elevance Health (Anthem)A cyst excision denied as cosmetic appealed from symptoms, prior treatment and pathology; 14 of 14 sentences sourced
Send back proof.
Free to start, no card. HIPAA compliant, with a business associate agreement for every clinic.