How it works  /  Payer remittance  ·  step 6 of 7
Payer remittance

The filing clock starts from the regulation, not a guess

The 835 is parsed, the CARC is classified by the playbook, and the appeal deadline comes with the authority that sets it.

What this changes for you

You stop missing appeal windows

The deadline arrives with the regulation that sets it and the evidence the appeal will need, on the day the remittance lands.

Most appeal deadlines are missed by accident

120 days for a Medicare redetermination is not a rule of thumb — it is 42 CFR 405.940-405.942, and the page cites it so nobody has to remember.

A denial category decides the whole strategy

Medical necessity, bundling, missing information and coverage termination need entirely different responses. Guessing wrong wastes the one appeal you get.

It tells you what evidence the appeal needs

Before anyone writes a letter: the policy, the chart evidence mapped to each criterion, the treatment history with dates.

Try it on your own words

Paste a real 835 or denial letter. Leave it empty to run the sample case. Use made-up details — this is a public page, so do not paste real patient information.

What the engine returned

era_835_parser.parse_era_835 + denial_playbook.classify_denial
denialCO-50 — Non-covered service — not deemed a medical necessity by the payer. Contractual Obligation — provider absorbs unless overturned; do not bill the patient.
deadlineRedetermination (MAC) — file within 120 days 42 CFR 405.940-405.942; Medicare Claims Processing Manual Ch. 29 §310.2
Classified: medical necessity Highest-value appeal. Pull the payer's specific medical policy (LCD/NCD for Medicare — the paired RARC tells you which: N115 = LCD-based, N386 = NCD-based; commercial CPB/medical policy for Aetna/UHC/Cigna).
Evidence the appeal needs Payer medical policy / LCD / NCD / CPB identified by ID (when available)
Evidence the appeal needs Chart evidence mapped to each policy criterion OR red-flag exception
Evidence the appeal needs Conservative treatment history with dates and duration (only if actually completed)

cached run · 6ms — deterministic, no model call — press Run this engine for your own text

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