Simulation briefing

Overturn the Denial

Jamie Reyes, appeals specialist at Northstar Billing Partners. Week two. No coding certification.

Meridian Health Plan denied prior authorization for a rheumatoid-arthritis biologic for one of Lakeside Rheumatology's patients. Your AI copilot, Sage, has read the case file and is ready to draft the appeal. Sage is fast, confident, and sometimes wrong. Your job is to check every claim it makes against the source before anything leaves this desk.

Denial reason: SC-14, step therapy not met (methotrexate ≥ 12 weeks required)
Case file: denial letter, two progress notes, medication list, PA request, payer policy excerpt
Every claim Sage makes carries a citation. Click it, read the line, then Verify or Flag.
You can escalate to a senior coder at any point in Level 3. That is not a failure.

Sage

AI appeals copilot

Marcus Bell

Practice manager, Lakeside Rheumatology

Nia

Your mentor

15 minutes, three levels Talk or type. Hold the mic to speak. Fictional case. No real data.

Talk to Sage like a colleague. Ask it where things are. Never let it tell you a claim is fine; read the line yourself.

Turn your sound on.