Why it matters
Most prior-auth rework is caused by an incomplete first submission. Gathering everything up front is slower once and faster overall.
Money
Prior Authorization Checklist
What to gather before you submit, so it is not returned.
What to gather before you submit, so it is not returned.
Most prior-auth rework is caused by an incomplete first submission. Gathering everything up front is slower once and faster overall.
The checklist
Written to be used and adapted. Take it, change the parts that do not fit your practice, and put a name against each line.
- Confirm authorisation is actually required for this payer and code
- Exact CPT and diagnosis codes, not descriptions
- Clinical documentation supporting medical necessity
- Any conservative-treatment history the payer requires
- Ordering provider details and NPI
- Submission reference recorded for follow-up
What is worth automating
Requirement lookup and document assembly are the automatable parts; medical-necessity narrative is not.
Rollout checklist
- Assign an owner to each line.
- Decide where this document lives so it is findable.
- Review it on a set cadence rather than after a failure.
- Train new staff against it rather than by shadowing alone.
Frequently asked questions
Can we adapt this?
Yes — it is written to be edited. The value is having one version everyone follows, not this exact wording.
Which parts should we automate?
Requirement lookup and document assembly are the automatable parts; medical-necessity narrative is not.
Keep going on MedReception.ai
MedFrontDesk.ai is the playbook library. MedReception.ai is the platform that runs it.