When the plan says no, give the patient somewhere to go
The coordinators who submit prior authorizations all day and receive the denials first. Apellica reads the denial for free, in writing, and prepares and files the appeal if it can be won. Nothing upfront for the patient; nothing paid or received by your office.
The denials you see
- Criteria not met with the documentation submitted
- Step therapy and site-of-care edits
- Peer-to-peer declined or lost
- Authorization approved for fewer units or a shorter period
The sentence at the desk
“The authorization came back denied. Give the patient this card: the appeal is theirs to file, and a free read tells them whether it is winnable.”
That is the whole workflow. The card carries a QR code with your referral code, the patient scans it while the denial is in their hand, and every start is attributed to your office.
What happens next
- 1The patient uploads the denial letter (photos are read on their device; only the text is sent). A reviewer answers in writing, usually the same business day: appealable or not, which rule, what deadline.
- 2If it can be won, Apellica prepares the internal appeal with the criteria demand, the record mapped to each criterion, and primary-source citations, then the external-review request if the plan holds.
- 3Your office is asked once for what only it can supply: the authorization request and the plan's determination with the criteria cited. The plan's criteria come with the request so the letter is written in one pass.
- 4The patient pays nothing upfront. If the appeal recovers coverage or money, the fee is 10% of the recovery; if not, nothing. Apellica is not a law firm and says so when a matter needs one.
What we will ask your office for
- The authorization request and the plan's determination with the criteria cited
- The denial letter the patient received (the patient uploads it; you need do nothing)
- A letter of medical necessity written to the plan's criteria, once, when the appeal is being prepared; we send the criteria with the request
- Nothing else: no contract, no fee, no data feed
The numbers your patients should know
- Prior authorization denial guide →
- Urgent claims must be decided within 72 hours →
- Answer: why was my prior authorization denied? →
Fewer than 1% of denied claims are appealed (KFF, 2024 HealthCare.gov filings). In California, independent reviewers sided with the patient in 52.5% of 42,710 decisions, and 72% in 2025 (DMHC). All research →
Your referral link
Codes use letters, digits and dashes; the suggested prefix for prior-authorization teams is pa-. Paste the link into the denial message you already send patients, or put the QR card at the desk.
https://apellica.com/start?ref=pa-yourname&utm_source=partner&utm_medium=referral&utm_campaign=pa-yourname
Questions prior-authorization teams ask
We resubmit, we do not appeal.
Resubmission is right when documentation was missing. When the plan applied criteria the patient does not meet on paper but does in fact, the member's appeal is the path, and it forces the plan to disclose the criteria.
Is there any fee or revenue share?
No. Apellica does not pay or accept referral fees. Anti-kickback and state fee-splitting rules make that a risk for both sides; it is a link, nothing more.