Method and system for managing appeals

A web-based computer system for managing insurance claim denials over a communications network, comprising:

• a hardware server for managing claim denials for a plurality of healthcare providers and comprising:
• a review module for comparing a claim denial of a healthcare provider to a denial status grid comprising a list of denial types and an appeal success rate for each denial type on the list, providing a recommendation to proceed with or to decline with an appeal of said claim denial based on the comparison and a patient record associated with said claim denial, wherein a determination to proceed with the appeal of said claim denial is based on the recommendation, preparing an appeals package comprising an appeals overturn letter and a supporting document in support of said appeal to said claim denial;
• an appeals coordinating module for submitting said appeals package to an insurer associated with said claim denial over said communications network to file said appeal of said claim denial;
• a managed care organization (MCO) process management module for monitoring the progress of said appeal filed with the insurer;
• and
• an appeal decision matrix module for processing appeal determination received from said insurer and determining whether to file a second level appeal when said appeal is denied or partially denied;
• a database for storing said claim denial, said patient medical record, said appeals package and said appeal determination;
• and
• a plurality of processor based client devices to access the server over the communications network, each client device associated with a health care provider.