How to Use the Letter Templates
Send Your Own Letter
- Members can use the Practice Management version to generate responses to insurance carriers.
Ask the ACR to Send a Letter
- The ACR sends letters on behalf of members, email us with any insurance issues. Please reference the ACR version of mailed letters on behalf of our members.
- Members can email drafted letters to Antanya Chung at AChung@rheumatology.org for ACR approval.
Letter Templates
Members please login to see the members-only version of this page.
Procedure Letter Templates
- Consultation Code Denials Template | ACR Version [Dec 2010]
- Bundling 20550 With Other Procedures Template | ACR Version [Jan 2010]
- MRI Letter Template | ACR Version [Mar 2011]
- MSK Procedures Denials Template | ACR Version [Mar 2011]
- VFA Letter Template | ACR Version [no date]
Lab Templates
- Denial of TB Tests for TNF Template | ACR Version [Mar 2008]
- Hepatitis B and Hepatitis C Denial Letter Template | ACR Version [Mar 2011]
Drug Letter Templates
- Welborn Health Plans- Rituximab Policy Template | ACR Version [Dec 2010]
- Administration of Abatacept - 90765 Template | ACR Version [Jan 2010]
- BC of PA Denial of Biologics Template | ACR Version [May 2010]
- Coventry HealthCare of GA- Denial of Humira Template | ACR Version [Jun 2010]
- Coventry HealthCare of VA- Infliximab Dosing Guidelines Template ACR Version [Nov 2010]
- CVS Caremark Specialty Drug Policy Template | ACR Version [Oct 2010]
- Denial of Rituximab Template | ACR Version [no date]
- Downcoding Infusions-Actemra-Tocilizumab Template | ACR Version [Mar 2010]
- Equal Access for Humira Template | ACR Version [Mar 2010]
- Humana Step Care Therapy Policies Template | ACR Version [Aug 2010]
- Kansas State Health Plan- specialty drug pilot program Template | ACR Version [Nov 2010]
- Palmetto- certolizumab pegol Template | ACR Version [Jul 2010]
- Regence Actemra Policy Response Template | ACR Version [Apr 2010]
- Regence Colchicine Policy Response Template | ACR Version [Mar 2010]
- Regence Fail First Policies Template | ACR Version [Aug 2010]
- Regence Medical Policy Manual Response Template | ACR Version [Sep 2010]
- Regence Rituxan Policy Response Template | ACR Version [May 2010]
- Trailblazer Ibandronate Template | ACR Version [Mar 2008]
E/M Letter Templates
- Modifier-25 Template | ACR Version [2010]
Other Letter Templates
- Wellmark BCBS failed treatment before prescribing biologics Template | ACR Version [March 2011]
- Accredo Brown Bagging Letter | ACR Version [June 2010]
- BS of NY Prior-Authorization for Prednisone Letter | ACR Version [Mar 2010]
- Frequent Documentation Requests | ACR Version [Feb 2008]
- Horizon BCBS-SubQFirst Template | ACR Version [Mar 2010]
- Trailblazer Documentation Letter Template | ACR Version [Aug 2009]
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