Appeal Generator — DentalSource

1 Provide the denial

Upload the EOB document (PDF or image) and we'll read the carrier, denial reasons, CDT codes, and amounts. Or skip to manual entry below.

+ Click to upload an EOB (Explanation of Benefits)

PHI in the document is not stored — only the structured fields you confirm in step 2 are sent to the letter generator.

OR ENTER MANUALLY

2 Confirm the denial details

Review and edit. The appeal letter is generated from these confirmed values, not the raw upload. Matched denial categories (in dark chips) pull in pre-built rebuttal language and required-evidence checklists.

Carrier / Payer

Carrier name (if "Other")

Claim number

Date of service

Provider / practice

Legacy aggregate denied ($) — optional

Total carrier-disputed

$0.00

Denied line items * — one row per EOB line; capture submitted/allowed/paid/patient + ref code + denial kind

Clinical findings supporting the appeal * No patient names, DOB, or SSN.

DATES IN THIS FIELD WILL BE REDACTED
Any dates you type in the clinical findings or per-line denial fields above will be replaced with [date redacted] in the generated letter, to protect patient privacy. Use the structured Date of service field above for the one date that should appear in the appeal.

Appeal letter

Strategy brief

Insurance Appeal Letter Generator