Appeal paperwork for denied back and neck surgery and spine scans, prepared for your practice
Updated November 5, 2026.
For medical practices and billing firms in Texas.
What Denial Reply prepares
Denial Reply prepares the appeal paperwork for a denied back or neck surgery, or a denied spine MRI or CT, as a packet your practice sends as the appellant. Each packet holds the following parts.
- A cover page listing everything in the packet.
- An appeal letter from your practice, in plain words about the plan's own rules.
- A criteria table: each item the rule asks for, where the records show it, and the page. An item with no page yet is marked [clinician to confirm].
- A deadline sheet with the dates that apply and where each one comes from.
- A clinician review and signature block: name, credentials, NPI, date, an attestation line and a signature line.
Criteria in the table come from public government text, such as a Medicare coverage policy or the federal WISeR guide. An insurer's own criteria are not copied. The letter asks the plan for them instead.
Your clinician reviews and signs every packet
Your clinician reviews and signs every packet. Nothing is sent until the named clinician has read it against the patient's records and signed.
Rules and templates only
Packets are built from fixed templates, a rules list and the facts your office enters. No AI model reads patient files, and none writes a letter. A check refuses to build a WISeR resubmission for any code that is not live in the program, and flags any claim in a letter that has no record page behind it.
Flat monthly pricing
Pricing is a flat monthly fee for your practice or billing firm. It is never a percentage of what is recovered.
Three sample packets
Each sample is a made-up case with no real patient, a fictional practice and a generic plan name. Every page carries a band that says so.
- SAMPLE, made-up case: WISeR resubmission for cervical fusion, CPT 22554, with a one-page peer-to-peer brief (PDF). WISeR is the Medicare prior authorization model running in Texas since January 2026. Of the cervical fusion codes, only CPT 22554 is live in it.
- SAMPLE, made-up case: Texas provider appeal of a denied lumbar spine MRI under a state-regulated plan (PDF). It cites Texas Insurance Code chapter 4201 and asks the plan for its screening criteria under section 4201.303.
- SAMPLE, made-up case: request that the appeal be reviewed by a provider of the same or a similar specialty (PDF). It cites section 4201.356(b) and its 10 working day and 15 working day limits.
Patient data and HIPAA, in plain words
- No office patient data is accepted on this site. Do not upload or email patient records here.
- A pilot with your practice runs on a separate server covered by a signed business associate agreement (BAA).
- The samples on this page are invented. They hold no real name, date of birth, member number or record.
Contact
To see a pilot or ask about your practice's most common denials, write to support@denialreply.com.
Sources used in the samples
- CMS WISeR Model, Provider and Supplier Operational Guide, version 7.0, July 24, 2026: https://www.cms.gov/priorities/innovation/files/wiser-provider-supplier-guide.pdf
- CMS WISeR Model page: https://www.cms.gov/priorities/innovation/innovation-models/wiser
- Texas Insurance Code chapter 4201: https://tcss.legis.texas.gov/resources/IN/htm/IN.4201.htm