How does Counterclaim generate an insurance appeal letter?

Counterclaim uses a 5-agent AI pipeline. The Reader extracts claim data from your document. The Researcher identifies applicable state insurance law. The Writer drafts a formal appeal letter. The Adversary identifies weaknesses. The Editor rewrites the letter to eliminate all weaknesses. The final letter is ready to print and mail in minutes.

Is Counterclaim free to use?

Yes - Counterclaim is free during the launch period. Upload your denial letter and receive a complete adversary-tested appeal letter at no cost. No account required.

What types of insurance denials can Counterclaim handle?

Counterclaim handles all major denial types: medical necessity (CO-50), prior authorization (CO-11), experimental treatment (PR-1), fee schedule (CO-45), timely filing (PR-27), not covered (CO-4), step therapy (PR-50), and missing information (CO-16).

What file formats does Counterclaim accept?

Counterclaim accepts PDF files, JPG and PNG photos, and scanned documents of your denial letter or Explanation of Benefits (EOB).

Does Counterclaim provide legal advice?

No. Counterclaim generates appeal letters based on publicly available legal and clinical information but does not constitute legal advice. For complex cases, consult a licensed healthcare attorney or certified patient advocate.

What is a PR-27 timely filing denial?

PR-27 is an ANSI reason code meaning 'expenses incurred after coverage terminated' or in common usage, 'claim not filed in a timely manner.' It means the insurer is refusing to pay because the claim arrived after their internal filing deadline.

Is a PR-27 timely filing denial always my fault as a patient?

Rarely. PR-27 denials are almost always the result of a provider billing error, the medical office filed late, submitted to the wrong insurer, or the claim was lost in transit. You should contact the provider's billing department first and ask them to supply proof of timely submission with their appeal.

What documentation proves timely filing?

Acceptable proof of timely filing includes: (1) electronic claim submission reports with date/time stamps; (2) clearinghouse acceptance confirmation; (3) USPS certified mail receipts; (4) payer acknowledgement reports; or (5) records showing coverage was incorrectly verified, which created 'good cause' for late submission.

What if the original claim was submitted on time but rejected for a different reason?

If a claim was submitted on time but initially rejected for a correctable reason (like a coding error), the corrected resubmission is typically still considered timely as long as the original was received before the deadline. Document the original submission date and include it in your appeal letter.

What is 'good cause' for a late filing exception?

Most insurers allow exceptions to filing deadlines for 'good cause', circumstances beyond the provider's or patient's control. Examples include: natural disasters, medical emergencies, provider bankruptcy, insurer-caused delays, incorrect eligibility verification at time of service, or administrative system failures. Document the good cause clearly in your appeal.

PR-27

How to Appeal a Timely Filing Denial (PR-27)

Claim denied for exceeding the timely filing limit (PR-27)? This common provider error can often be reversed. Learn how to appeal with proof of timely submission and get your claim paid.

What does PR-27 mean?

A PR-27 denial means the claim was submitted to the insurer after the deadline specified in the provider's contract or the plan's benefit document. Timely filing limits typically range from 90 days to 1 year from the date of service, and insurers strictly enforce them as a cost-control measure.

Why insurers issue PR-27 denials

PR-27 denials are almost always a provider-side administrative error: a billing department that filed late, a claim submitted to the wrong insurer, a claims submission system glitch, or a delay in receiving patient insurance information. The patient is rarely at fault, but they receive the bill.

Appeal strategy

The key to a successful PR-27 appeal is documentation proving the claim was submitted on time: claim submission logs, clearing house acceptance reports, postal receipts, or electronic submission confirmations. If the claim was submitted to the wrong insurer due to incorrect information provided at the time of service, this constitutes 'good cause' for waiving the deadline.

Frequently asked questions about PR-27

CO-50

Medical Necessity Denial (CO-50)

CO-11

Prior Authorization Denial (CO-11)

CO-55

Experimental Treatment Denial (CO-55)

CO-45

Exceeds Fee Schedule Denial (CO-45)