Prior Authorization Denial Appeal Letter

Build a letter to appeal a prior authorization denial with the denial reason, medical necessity summary, and attached evidence.

Appeal a prior authorization denial

All fields are optional. Add denial details, medical necessity, and attachments.

Status message placeholder

Policyholder Name

Address

Insurance Company

Policy Number

Member ID

Patient Name

Provider Name

Service / Procedure Requested

Prior Auth / Reference Number

Denial Date

Denial Reason

Medical Necessity Summary

Attachments Included

Creates a prior auth denial appeal letter with an attachments checklist.

🔒 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.