Claim Denial Decoder Skill

Denial letters are written to end conversations; appeals exist because they often shouldn't. A meaningful share of denials — especially coding errors, "not medically necessary," and documentation gaps — get overturned when someone answers the stated reason with evidence instead of outrage. This skill decodes what the denial actually claims, matches each claim to the evidence that answers it, and writes the appeal that reads like it was drafted by someone who will escalate.

What This Skill Produces

• The denial decoded: the cited reason in plain language, and what that reason-type means for appeal odds
• An evidence checklist matched to the denial type — what to gather before writing
• The appeal letter — point-by-point, document-cited, deadline-aware
• The escalation ladder — internal appeal levels, external/independent review, regulator complaint — in order

Required Inputs

Ask for these only if they aren't already provided:

• The denial letter text — the cited reason codes/language, and the stated appeal deadline. No letter yet? First move is requesting the denial in writing with the specific policy basis.
• The claim story — what was claimed, when, the loss or treatment, and any prior authorizations or adjuster interactions.
• The policy language if available — the appeal's strongest sentences quote the policy against the denial.
• What's already been sent — and what the insurer claims it never received (the classic).