Medical Billing Templates and Appeal Letters

What’s included in these templates

All 15 templates are free downloads — 14 editable Word documents and one Excel log. Each one downloads directly.

Denial Appeal Letter Template

a fill-in-the-blank first-level appeal letter that can be adapted to any payer

Prior Authorization Request Letter

a pre-written prior authorization request with a clinical justification framework

Patient Financial Responsibility Form

a form patients sign acknowledging their payment obligations

Insurance Verification Form

a structured form for capturing eligibility details at check-in

Billing Follow-Up Log Template

an Excel log for tracking unpaid claims, follow-up dates, notes and resolution status

Second-Level Appeal Letter

an escalated appeal letter with stronger clinical and regulatory language

Peer-to-Peer Review Request Form

a request form for prior authorization peer-to-peer review calls

Advance Beneficiary Notice (ABN)

the CMS-required Medicare waiver form

Payment Plan Agreement

a patient installment payment agreement

Overpayment Refund Letter

a letter notifying a payer of an overpayment and initiating a refund

Collection Notice Series (3 letters)

30, 60 and 90-day patient balance collection letters

Superbill Template (by specialty)

primary care, mental health and physical therapy versions

Notice of Privacy Practices (NPP)

the HIPAA-required patient privacy notice

HIPAA Authorization Form

a patient consent form for releasing medical records

Financial Hardship Application

a charity care and fee reduction application for patients

Templates are a starting point, not legal or billing advice. Review the wording against your own payer contracts and state requirements before sending anything to a patient or an insurer.