We prepare the appeals your staff has no time to write.
Send us the denial and the chart excerpt. We match every policy criterion to a dated document and draft the letter; your clinician approves it in minutes.
How one denial becomes a packet your clinician can sign.
This is item 2 of the worked example. The plan, the practice and the reviewer are fictional; the record underneath is the real one every pilot gets.
The denial
Example Health Plan (fictional)
CT abdomen and pelvis with contrast,
CPT 74177Denied 2026-09-05
“Clinical indication does not meet criteria for advanced imaging (policy IMG-210).”
The reason the plan gave
The payer's own rule, quoted word for word
CT of the abdomen and pelvis is considered medically necessary for suspected appendicitis or intra-abdominal abscess when ultrasound is non-diagnostic or unavailable1 and the patient has fever2 or leukocytosis3.
Policy
IMG-210, section 1(a), Example Health Plan-
Every criterion gets a document and a date. A reviewer at the payer checks dates first, so the packet never says “see chart”.
What is missing gets an owner. When a document is not in the excerpt, the packet names it and who fetches it, before anything is submitted.
The chart, matched criterion by criterion
Criterion Document Dated What it shows 1 Ultrasound report 2026-08-30 Non-diagnostic 2 Office note 2026-09-01 Fever of 38.4 C 3 Laboratory report 2026-08-31 White count 14,200 Missing: nothing. Each criterion is met.
The letter, drafted
“The ultrasound report dated 2026-08-30 is non-diagnostic; the office note dated 2026-09-01 documents fever of 38.4 C; the laboratory report dated 2026-08-31 documents a white count of 14,200. Each criterion is met. We ask that the authorization be approved.”
From the letter we drafted for the reviewer
Your clinician decides
Approved
“Quoted and dated. Submit.” Dr Example (fictional reviewer)
Prepared under a rule this reviewer wrote on item 1: “Quote the policy criterion word for word and give the date of every note you rely on.” A correction becomes a rule, and the next packet cannot enter the record without citing it.
The record
Event 5 of 6,
item.decidedChained to every event before it and signed. Check it yourself.
Follow the other denial through the record, one event at a time.
Every fact below is pulled from one pilot's own record, at /example/ledger.json: made-up practice and denials; the record and verifier are real.
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1. The denial arrives
Example Health Plan (fictional). MRI lumbar spine without contrast, CPT 72148. Denied 2026-09-02. Reason given: "Documentation does not establish six weeks of conservative therapy prior to advanced imaging (policy…
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2. The packet is prepared
Mapped to the payer's policy: "IMG-104 section 2(b): six weeks of documented conservative therapy including physical therapy or a home exercise program, and a trial of anti-inflammatory medication, before lumbar MRI in the absence of red flags."
The letter drafted for the reviewer opens: "Dear Appeals Reviewer, we request reconsideration of the denial dated 2026-09-02 for lumbar MRI (72148). The record documents eight weeks of physical therapy and a six-week course of naproxen, which exceeds the six…"
Evidence listed: PT progress notes 2026-06-15, 2026-07-08, 2026-08-10 (14 visits documented), Medication list showing naproxen course 2026-06-15 to 2026-07-30, Office note 2026-08-24: radicular pain persists after conservative care.
Still missing: Physical therapy discharge summary (requested from the PT clinic; owner: front desk).
Next to act: Biller to attach the PT discharge summary before submission.
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3. The reviewer writes a correction
Dr Example (fictional reviewer) on item 1: "Quote the policy criterion word for word and give the date of every note you rely on."
That correction is now a rule. No later item can enter the record without citing it.
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4. The next packet cites the rule and is approved
Item 2 cites the rule written after item 1: "Quote the policy criterion word for word and give the date of every note you rely on."
Decision: approved by Dr Example (fictional reviewer).
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5. The record is sealed
Head: event 6, hash
a47ef9cbb97be274…, signed with key3bdb547d2019.
Step 1 of 5
Most denials are never appealed, and most appeals that are filed win.
| Figure | What it counts | Measured by |
|---|---|---|
| 40 | prior authorizations per physician, per week | AMA 2025 physician survey, May 2026 |
| 13 hours | of physician and staff time on them, per physician, per week | AMA 2025 physician survey, May 2026 |
| 21% | of physicians say they always appeal a denial | AMA 2025 physician survey, May 2026 |
| 67% | of appealed Medicare Advantage denials were overturned in 2025 | KFF, 13 Aug 2026 |
| $12.88 | provider cost of one manual prior authorization | CAQH Index 2024, 2025 |
Every decision is sealed, and you can check it without asking us.
Each item, each decision and each correction is one event in a chain. Each event's fingerprint covers its content and the event before it. After every event the head of the chain is signed with a key whose public half is published at the public key.
The command answers "ok": true only if every fingerprint matches, the signature verifies, and the count of completed items is the count in the chain. Change one character of the export and it answers "ok": false with the reason. Auditors, payers and partners can run the same command. See a worked example: two made-up denials, one correction, the real record underneath.
Export your record and run this from any machine
curl -s 'https://strategic-innovations.ai/v1/pilots/YOUR_PILOT/ledger?key=YOUR_KEY' \
| curl -s -X POST -H 'content-type: application/json' \
--data-binary @- https://strategic-innovations.ai/v1/ledger/verify
$39 a packet, or $2,500 a month for a queue of 400.
Every fee checks out on Stripe. Prices dated 17 September 2026.
| Service | Fee | What you get | Buy |
|---|---|---|---|
| Appeal packet | $39a packet, no subscription | One appeal packet from one de-identified denial, in your console within two working days. Choose how many at checkout; your first packet is free. Approve, correct or reject each one; every decision goes on your sealed record. | Buy packets at $39 each |
| Pilot design | $499once, credited against the first month | A written design of your queue within five working days of payment: the queue, its owner, the approval gate, the exception path, baseline volume and the scorecard the pilot is judged on. Reply to the receipt to book the 30-minute scoping call. | Start with the design |
| Managed pilot | $2,500a month, month to month | One queue, one reviewer on your side and a person on ours. 400 completed items included, then $6 an item, invoiced monthly from the record. Rejected items are recorded and never charged. The reviewer console, the sealed record and the verifier are included. | Start the managed pilot |
Groups with volume, vendor review or legal terms to settle are priced per completed item under a written agreement: sales@strategic-innovations.ai.
Your team keeps its payer portals, your reviewer signs every packet, and patient data moves only under a signed BAA.
- Your people keep the portal. The packet arrives ready, and someone on your team submits it through the portal they already use. We never log in to a payer site for you.
- Your reviewer signs every one. Each packet carries an approval recorded in your console before it goes anywhere. The record names the reviewer, the decision and the time.
- Patient data moves under your BAA. Denials and chart excerpts arrive by secure upload under a signed Business Associate Agreement, and email never carries patient data. The design names the sources before the first item.
- Your results come from your own record. Every number on this page links to who measured it and when, and your scorecard is counted from your sealed record.
Independent specialty practices, DME and home-health operators.
The buyer is usually the revenue cycle director or the practice administrator: the person who sees the denial report, carries the authorization staff on the payroll, and can buy a $39 packet on a card today. Start with the free packet, buy a few on real denials, and move to the $2,500 queue only when the packets have earned it.