Step 5 of 8

Pick the right document, then draft it

A corrected claim, a reprocessing request, a reconsideration and an appeal are four different things. Here is which one Yeam drafts, and why.

The costliest mistake in denial work is the right argument in the wrong document. An appeal for a coding error uses up the filing window on something a corrected claim would have fixed. An appeal for the payer’s own mistake asks them to defend a decision they should simply correct.

The four documents

Corrected claim: you fix your own mistake

The claim had a wrong or missing code, modifier or detail. You fix it and send the claim again as a replacement for the original. It goes back through your clearinghouse, not to the appeals department, and it is not an appeal.

Reprocessing request: the payer made the mistake

The payer processed the claim wrong, for example at the wrong rate or under the wrong plan. Do not write an appeal for this. Send it back for reprocessing: say what they got wrong, point to the document that shows it, like your fee schedule, and ask them to process the claim again. No medical argument, and it stays short.

Reconsideration: ask them to look again

Something on the claim was missed or misread, and you want the payer to take a second look. It sits between a corrected claim and a formal appeal. Your payer’s provider manual says when they expect one.

Appeal: you disagree with the decision

The payer decided against the claim on its merits, like medical necessity, prior authorization, bundling or the number of units, and you have evidence the decision was wrong. Appeals have a deadline that runs from the date on the remittance, and Yeam counts it for you.

Which one Yeam picks

Yeam reads the reason code on each denial. The worklist’s What it needs column shows its call, and Draft the response writes that document.

CO-11: What the payer said: The diagnosis does not support the procedure; Yeam drafts: Corrected claim
CO-16: What the payer said: The claim is missing information; Yeam drafts: Corrected claim
CO-18: What the payer said: Duplicate claim or service; Yeam drafts: Corrected claim
CO-45: What the payer said: The charge is above the fee schedule or contract; Yeam drafts: Reprocessing request
PR-204: What the payer said: Not covered under the patient's current plan; Yeam drafts: Reprocessing request
CO-50: What the payer said: Not medically necessary; Yeam drafts: Appeal
CO-97: What the payer said: Included in another service already paid; Yeam drafts: Appeal
CO-151: What the payer said: More services or units than they allow; Yeam drafts: Appeal
CO-197: What the payer said: No prior authorization; Yeam drafts: Appeal
PR-1 PR-2 PR-3: What the payer said: Deductible, coinsurance, copay; Yeam drafts: Nothing to send. Bill the patient.

Code	What the payer said	Yeam drafts
`CO-11`	The diagnosis does not support the procedure	Corrected claim
`CO-16`	The claim is missing information	Corrected claim
`CO-18`	Duplicate claim or service	Corrected claim
`CO-45`	The charge is above the fee schedule or contract	Reprocessing request
`PR-204`	Not covered under the patient's current plan	Reprocessing request
`CO-50`	Not medically necessary	Appeal
`CO-97`	Included in another service already paid	Appeal
`CO-151`	More services or units than they allow	Appeal
`CO-197`	No prior authorization	Appeal
`PR-1` `PR-2` `PR-3`	Deductible, coinsurance, copay	Nothing to send. Bill the patient.

For CO-45, the reprocessing request argues only the rate: your contracted rate against the rate the payer applied. If they paid your contracted rate, there is nothing to dispute. Post it as a contractual adjustment.

Yeam does not pick a reconsideration on its own yet. If a payer wants one, change the heading and opening line of the draft before you save it. You know your payers: if you disagree with the document Yeam picked, edit it the same way.

Draft it

On the worklist, click Work or Open on a row.
A panel opens beside the list and steps through Note, Letter, Send and Outcome. Move between them with the buttons at the bottom of the panel.
Write a note, if you have talked to the payer.
Put down what they told you: “Called Aetna, rep said the auth was on file under the referring NPI, wants it resubmitted with the rendering NPI, ref 4471902.” Yeam treats your note as the most reliable fact on the claim and builds the document around it. Write the note with Yeam turns rough notes into a clean one without adding anything you did not say.
Notes are saved as you type them, so leave patient names out.
Tell Yeam how you want it written, if you like.
The box Anything Yeam should know before it writes? takes direction like Keep it short, Plain language, no jargon, Cite the payer policy, Lead with the dollar amount, or your own words. It changes how the document reads, never what it claims.
Click Draft the response.
Give it a few seconds.
Read it, and leave the brackets alone.
The draft has blanks like [PATIENT NAME] and [MEMBER ID]. Do not type patient details into the letter. Fill them in the Complete the letter boxes underneath, which stay in your browser. Yeam will not save a letter with those brackets removed.
Edit anything else.
Type straight into the letter, then click Save as v2. Every version stays in the list, nothing is overwritten. To change it in words instead, type in Ask for a change at the bottom, like “make it shorter”.
Check Preview it filled in.
That is the finished letter, with the patient details merged in, shown only in your browser.

Before your first draft

Fill in Settings, then Workspace signature block: practice name, NPI, tax ID and address. Every draft signs with it. Without it, drafts end with [PRACTICE NAME] for you to fill in.

Follow along

Open CLM-2026-5228 (Blue Cross Blue Shield of Texas, CO-11) and draft it. Notice it is a short cover sheet for a resubmission, not an appeal. Then open CLM-2026-5094 (UnitedHealthcare, CO-197) and draft that one: it is an appeal, about the missing authorization. Next: send it and record it.