Appeals for speech therapy practices, built from your chart.
Appeals turn on standardized test scores or instrumental findings, measurable communication or swallowing goals, and documented progress. Matches each payer rule to the evaluation scores, goals and session notes, for adult neurogenic, swallowing, voice and pediatric language caseloads.
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What the reviewer looks for.
These are the points a speech-language pathology appeal has to prove. ClaimDoc checks each one against your record and names the page that proves it, or the document that is missing.
Evaluation with standardized or instrumental findings
An evaluation documents the diagnosis, the communication or swallowing impairment and its severity with standardized scores or instrumental or clinical findings.
Plan of care with measurable goals
A written plan states measurable goals and the type, frequency and duration of treatment.
Services needed a speech-language pathologist
The session notes show treatment that required the skills of a speech-language pathologist, with the techniques used and the client's response.
Measurable progress
Re-measurement shows objective progress toward the goals, or skilled care needed to maintain function.
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.
- Speech-language evaluationneededStandardized scores or instrumental findings set the baseline and prove a disorder, not a variation.
- Plan of care with the physician's or NPP's signature and dateneededMedicare and many plans require the certified plan to cover the denied dates.
- Session notes for the denied datesneededProve the skilled treatment delivered each day.
- Progress reportsShow re-measurement against the baseline.
- Standardized scores (CELF-5, PLS-5, GFTA-3, WAB, MBSImP)Re-tested scores make progress objective.
Denials it handles.
Plain words first. For each, what usually decides the appeal.
“Not medically necessary”
Scores that show a disorder, goals tied to them and re-measurement.
“Visit limit reached”
Habilitative versus rehabilitative benefit wording in the plan, and the plan's exception path.
“No prior authorization on file”
The approval and its number, or proof an authorization was not required.
The rules ClaimDoc holds for speech-language pathology.
Stored word for word
- Medicare Benefit Policy Manual, Chapter 15, §220–230 (Outpatient therapy)
- MLN905365: Complying with Outpatient Rehabilitation Therapy Documentation Requirements
- CMS Therapy Services: KX modifier threshold
- Jimmo v. Sebelius settlement: skilled maintenance therapy
- Medicare Claims Processing Manual, Chapter 5 (Part B outpatient rehabilitation), §10–20
Medicare coverage on file
5 local and national coverage documents from CMS, across 3 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
- UnitedHealthcare
- Original Medicare (Part A outpatient and Part B)
- Aetna
- Aetna Medicare Advantage
- Alignment Healthcare
- Cigna Medicare Advantage
- Clover Health
- Devoted Health
- Humana
- 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.
- UnitedHealthcareA child's language-disorder therapy appealed from test scores and progress probes; 13 of 13 sentences sourced
Send back proof.
Free to start, no card. HIPAA compliant, with a business associate agreement for every clinic.