For Medical Billing & Coding Specialists ·
What you'll accomplish
By the end of this guide, you'll have a Claude Project — a dedicated AI assistant that already knows your specialty, your top payers, your common denial types, and how you like appeal letters written. Every conversation you start in this project instantly understands your billing context, so you never explain yourself twice.
What you'll need
Go to claude.ai and sign up with your email. The free plan works for this guide; Claude Pro gives unlimited conversations and is worth it if you use this daily.
What you should see: After signing in, you'll see the main Claude chat interface.
Look at the left sidebar. You should see a "Projects" section. Click "New Project" or the + icon next to Projects.
What you should see: A new project creation screen with a name field and a "Project instructions" text area.
Troubleshooting: If you don't see Projects, you may be on the free tier — Projects is included in the free tier but may require confirming your account. If it's still missing, try logging out and back in.
Give it a clear name like "Medical Billing Assistant" or "[Your Specialty] Billing" (e.g., "Orthopedic Billing Assistant").
This is the most important step — the instructions tell Claude who you are and how to help you. Click in the "Project Instructions" area and enter your context. Here's a template:
You are a medical billing assistant for a [specialty] practice. Here is my context:
SPECIALTY: [e.g., Orthopedic Surgery / Family Medicine / Behavioral Health]
TOP PAYERS I WORK WITH:
- Medicare
- [Payer 2, e.g., Aetna]
- [Payer 3, e.g., BCBS]
- [Payer 4]
- [Payer 5]
MOST COMMON CPT CODES I BILL:
[List your top 10-15 codes, e.g., 99213, 99214, 99215, 97110, 27447]
COMMON DENIAL TYPES I DEAL WITH:
- [e.g., CO-4 modifier issues]
- [e.g., CO-50 medical necessity]
- [e.g., CO-97 bundling]
- [e.g., CO-29 timely filing]
HOW I LIKE APPEAL LETTERS:
- Professional but not stiff
- 3-4 paragraphs maximum
- Always cite the specific denial code
- Always end with a clear request for reconsideration and contact information placeholder
- Avoid over-explaining — payer reviewers are busy
WHAT I DO NOT WANT:
- Patient names or PHI in any output (I will add those myself)
- Hallucinated policy citations — if you're unsure of a specific payer policy, say so
- Overly generic language — tailor to the specific payer and situation I describe
When I ask you to draft an appeal letter, always ask if I haven't already provided: (1) the denial code, (2) the CPT code, (3) the payer name, and (4) the clinical context.
Fill in the brackets with your actual information. This takes about 10 minutes.
What you should see: Your instructions fill the text area. Click "Save" or "Create Project."
Start a new conversation within the project by clicking "New Chat" or "Start a conversation" while in the project.
Ask it something simple: "What are you set up to help me with?"
What you should see: Claude responds with a summary of your specialty, payers, and what it's ready to help with — demonstrating it read your instructions.
Try drafting an appeal: "Draft an appeal for UHC who denied 99214 with CO-50. Patient is an established Medicare patient with type 2 diabetes, complex medication management required. The visit complexity was high."
What you should see: Claude produces an appeal letter already structured the way you specified — the right length, the right tone, citing the denial code, ending with reconsideration language. No re-explaining your preferences.
Daily triage question:
I have these denials to work today: [list denial codes and CPT codes]. Which should I prioritize first and why?
Policy interpretation:
Does [payer name] typically cover [procedure] for [diagnosis]? What documentation is usually required? Note any uncertainty you have.
Modifier guidance:
I'm billing [CPT code] with modifier [modifier] for [payer]. Is this the right modifier combination? What are the common issues with this payer and this code combination?
Provider education:
A physician keeps getting CO-50 denials on 99215 from Medicare. What are the most common documentation deficiencies that cause this and how should I explain it to them?