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APPEAL WORKFLOW WORKBOOK
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Based on UnitedHealthcare published 65-day commercial appeal window and AMA 2024 Prior Authorization Survey | RapidClaims
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WHY THIS WORKBOOK EXISTS
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UHC commercial appeals have a 65-day window — the shortest in the industry. Most appeals teams run a shared calendar across all payers, which means UHC denials silently age out while Aetna/BCBS/Cigna denials still have 115 days left. This workbook gives you the priority scoring formula, the payer-specific deadline matrix, and the aging tracker to surface the right appeals at the right time.
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WHAT'S INSIDE
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TABWHAT IT CONTAINSWHEN TO USETIME
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1. READMEHow to use, color legend, disclaimerFirst time only5 min
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2. Priority CalculatorLive calculator — enter denials, get priority scores rankedDaily/weekly10 min
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3. Payer Deadline Matrix5-payer appeal deadline reference cardReference5 min
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4. Overturn Rates by CategoryDenial-category overturn probability with peer-to-peer upliftReference5 min
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5. Aging TrackerDaily aging report template — flags UHC denials at day 5DailyBuild into workflow
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6. Readiness Scorecard12-question quarterly reviewQuarterly15 min
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7. Sources & Change LogPrimary sources, version historyReference—
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COLOR LEGEND
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LEVELMEANINGBGTEXT
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URGENTTop priority — work first todayFAD7D78B0000
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HIGHSurface this weekFDEBD0D68910
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STANDARDStandard appeal queue cadenceD5F0E10D7680
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EDITABLEEnter your data in yellow cellsFFF9DB1A1A1A
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DISCLAIMER
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Appeal deadlines vary by plan type, state, and participation agreement. Always verify the specific window in your current UHC participation agreement before applying these defaults. Overturn rate estimates are drawn from publicly reported industry sources and AMA survey data — actual outcomes vary by specialty, documentation quality, and case complexity. Not legal or compliance advice.
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