Insurance Claim Reprocessing Request Letter

Build a letter asking the insurer to reprocess a claim due to coding errors, missing information, or misapplied patient responsibility.

Request claim reprocessing

All fields are optional. Include corrected details and supporting items.

Status message placeholder

Policyholder Name

Address

Insurance Company

Policy Number

Member ID

Patient Name

Claim Number

Date(s) of Service

Provider / Facility

Reason for Reprocessing

Corrections / Details

Attachments Included

Generates a reprocessing letter with corrections and an attachments list.

🔒 MANDATORY CODEX SAFETY FOOTER (INCLUDE VERBATIM)

Do not modify global layout, header, footer, ads, analytics, or shared components
Do not import @/components/ui/select or any unverified shadcn components
Use native HTML inputs only
Row add/remove buttons must be plain <button>
No date math, no parsing, no calculations
PDF builders must return Promise<Uint8Array>
Always create Blobs using bytesToPdfBlob(bytes) from lib/pdf/bytes.ts
Never include null in React-PDF style arrays
No refactors
Tool may only break itself

Processing stays in your browser. PDFs generate locally—no uploads or accounts.
Downloads use a secure PDF blob helper (no raw array buffers or workers required).
Review details before sending; nothing here is legal advice or a substitute for local forms.