Understand why a claim was denied and send a calm, complete appeal. Copy a prompt and paste it into ChatGPT or Claude. It may ask up to 3 quick questions.
Prompts
Explain why a claim was denied
When to use it: To understand an EOB code before calling the carrier.
It will ask you: Paste the denial or remark code and its wording (no patient details).
You are helping a dental billing team understand a claim denial. Keep it under 150 words: item 1 in one sentence, items 2 and 3 as 3 bullets of under 12 words each, item 4 as 2 short questions. Give me:
1. What the code usually means, in plain words. (required)
2. The 3 most common reasons offices get it.
3. What to check in our own records before calling the insurance company.
4. Two questions to ask the insurance company.
If you are not sure what the code means for this carrier, say so. Do not guess.
Before you write, ask me only these questions, in one short numbered list. Do not add other questions. Do not repeat my instructions back to me; just ask the questions. Then wait for my answers:
1. Paste the denial or remark code and its wording (no patient details). (required)
If I skip a question marked (required), say in one line why you need it and ask again. If I skip any other question, use a placeholder in curly brackets that names the missing fact, like {Practice name}, instead of guessing. Never ask for patient names or other patient details.
Write an appeal letter
When to use it: When a claim is denied and you need a clear, firm letter.
It will ask you: What was the procedure (code and name)? · What denial reason did the insurance company give?
You are helping a dental billing team. Write an appeal letter template for a denied dental claim.
Rules:
- Use these placeholders: {Patient name}, {Member ID}, {Claim number}, {Date of service}, {Practice name}, {Practice address}. Our team fills them in later in our practice software, never in this chat. Keep {curly bracket} placeholders exactly as written.
- Leave two clearly marked spots: {Why we disagree, in our team's words} and {Dentist: clinical reason goes here}. Do not write any facts about the patient, their history, their benefits or our records, and do not say the denial was wrong. Our team writes those parts.
- Calm, professional and firm. Under 300 words.
- After the letter, list the documents to attach for this denial reason. Write {Practice name} and {Practice address} in curly brackets everywhere, including the letterhead and signature. Never say the care was needed, necessary or correct, or that the claim is valid. If I skip a question, write {Procedure} or {Denial reason} in its place. Between the facts and the two marked spots, write no sentence of your own except "We request a review of this claim."; never write "we disagree" or that the claim should be paid.
Before you write, ask me only these questions, in one short numbered list. Do not add other questions. Do not repeat my instructions back to me; just ask the questions. Then wait for my answers:
1. What was the procedure (code and name)?
2. What denial reason did the insurance company give?
If I skip a question, use a placeholder in curly brackets that names the missing fact, like {Practice name}, instead of guessing. Never ask for patient names or other patient details.
Take notes on a claim call
When to use it: To keep claim calls short and well documented.
You are helping a dental billing team. Make a short note template to fill in after calling an insurance company about an unpaid claim.
Fields: date of call, rep name, call reference number, claim status, what is missing, next step, follow-up date. Write each one as "Field: ________".
Then add 5 good questions to ask when a claim is over 30 days old.
Rules: Plain text, under 200 words. No patient information. Write it now, without asking me anything. No bold and no stars; write each blank as ________.
Privacy: never ask me for, or include, patient names or other patient details.
Prepare a pre-authorization
When to use it: Before sending a pre-authorization for major work.
It will ask you: Which procedure is it for (for example a crown, bridge, implant, or scaling and root planing)?
You are helping a dental office send a pre-authorization. Make a one-page checklist: the usual attachments, what the dentist's narrative usually covers, and the most common reasons these get sent back.
Rules: Leave one marked spot: {Dentist writes the clinical reasons here}. Do not write clinical findings yourself. Put a checkbox (☐) before each item. Under 300 words. Put ☐ before every line, including the {Dentist writes the clinical reasons here} line. Write placeholders without backticks. Do not state time limits like "within 12 months". Write {Tooth number} wherever a tooth is named. In the narrative section, list topic names only, each followed by a blank, like "☐ Prognosis: ________"; never fill in a diagnosis, prognosis, reason or material. Section titles have no ☐; every other line has exactly one ☐. Write the dentist line exactly as "☐ {Dentist writes the clinical reasons here}", with the curly brackets, even when I skip.
Before you write, ask me only these questions, in one short numbered list. Do not add other questions. Do not repeat my instructions back to me; just ask the questions. Then wait for my answers:
1. Which procedure is it for (for example a crown, bridge, implant, or scaling and root planing)?
If I skip a question, use a placeholder in curly brackets that names the missing fact, like {Practice name}, instead of guessing. Never ask for patient names or other patient details.
What you will get
EXAMPLE FOR A MADE-UP PRACTICE
This denial (CARC 119) means the plan has already paid the most it allows for this time period.
Check first: the plan year dates and every service billed for this patient this year.
Check before you use it
Your billing lead and dentist review it. Only the dentist writes the clinical reason. Rules differ by plan, so confirm with the payer.
Limits
These prompts help with office work. They are not clinical, legal or billing advice, and AI can make mistakes. A person on your team checks every draft before it is used.
Questions
Can I paste patient information?
No. Never paste patient names, birth dates, phone numbers, member IDs, claim numbers, dates of service or chart notes into an AI tool. These prompts never ask for them.
Which AI tool should I use?
Any chat AI works, like ChatGPT or Claude. Use only the AI tools your practice has approved.
Is it free?
Yes. Every prompt is free to copy. No sign-up needed.
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Tuesday and Thursday at 7 AM ET. Reviewed by Dr. Roshan Parikh, DDS.