Productivity
Assemble a prior authorisation
The documentation the payer's own criteria asks for, in their order.
Fill it in
Notes, history and prior treatments.
Point-by-point, in their sequence.
Step therapy is the most common denial reason.
Your prompt
Assemble the request from . Follow the payer's OWN criteria, point by point, in their sequence. A request that documents everything relevant in a different order is read by a reviewer with a checklist who cannot find item three, and it is denied for missing information that was on page four. Document what was already tried, with dates and outcomes. Step therapy is the most common reason these are refused, and "conservative treatment failed" without the record is not documentation. Cite the codes exactly, and make sure the diagnosis supports the requested service on its face. Include the clinical rationale in two or three sentences at the top. Everything else is evidence for it. Fictional patient only.
Continue and pick your folderOpens with everything above already filled in.
Why this works
A request that documents everything relevant in a different order is read by a reviewer with a checklist who cannot find item three, and it is denied for missing information that was on page four. This follows the payer's criteria point by point.