Appeal Letter Templates
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HCV DAA Treatment Appeal Letters (Updated 3/9/17)

Denial Appeal - GT1 Naive, F0-2, 8 Wk Treatment with Harvoni View/Download
Denial Appeal - GT1 Naive 12 Wk Treatment With ViekiraPak and Riba for Cirrhotic INF Contraindicated Patient View/Download
Denial Appeal - GT1 8-Week Sovaldi for INF Contraindicated Patient View/Download
Denial Appeal - GT1 Harvoni Re-Treate Post Sofosbuvir and Ribavirin Relapse View/Download
Denial Appeal - GT2 Re-Treat with Sovaldi and Riba Post INF-Riba Fail View/Download
Denial Appeal - GT3 Naive 12 Wk Treatment With Daklinza-Sovaldi View/Download
Denial Appeal - Generic GT3 Naive 12 wks F0-2 DacSof View/Download
Denial Appeal - GT1 12-24-Week Harvoni and Riba for decompensated INF Contraindicated Patient View/Download

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