Medical-Necessity Escalation Memo

The standard desk deliverable. A fixed 12-section physician memo that maps the denied case to the criteria the payer reviewer actually applied — producing handoff-ready reasoning your appeal writer can use directly. Covers inpatient medical-necessity, short-stay, and specialty denials across all appeal levels.

• Case denied on medical-necessity grounds
• Internal team has reviewed and cannot construct the clinical argument
• Appeal needs criteria-mapped reasoning beyond narrative
• Level 2 or external review requires a materially different argument

Appealability verdict · Payer rationale analysis · Clinical facts that matter · Where the denial logic is weak · Criteria-style argument · Documentation gaps · Appeal-writer instructions · Risk-of-failure assessment.