Prepare a prior authorization request that gets approved first time

Help me prepare a prior authorization request. Payer and plan: [e.g. "Medicare Advantage HMO", "state Medicaid MCO"] Service requested: [CPT/HCPCS code(s), drug name, imaging study, DME, or procedure] Diagnosis codes as documented by the provider: [ICD-10] Payer's coverage criteria: [PASTE the medical policy or criteria checklist] Documentation we have: [SUMMARY - prior treatments tried and dates, test results, notes, as recorded by our clinicians] Urgency: [standard / expedited - and the provider's stated reason if expedited] Submission method: [portal, fax, electronic PA] Do this: 1. Build a criteria crosswalk table: Payer criterion | Where it is met in our documentation (cite the note and date) | Status (met / partly met / missing). 2. List each gap and what document or information would close it. Do not suggest altering or adding clinical facts; only point to what may already exist in the chart or needs the provider's input. 3. Draft a concise letter of medical necessity summary for the provider to review and sign, using only the facts I gave you, with [PROVIDER TO CONFIRM] where needed. 4. Give a submission checklist: correct codes, NPI and tax ID, site of service, units, dates, and attachments. 5. Draft talking points for a peer-to-peer review in case of denial, organized by criterion. 6. Note expected decision timelines to [CONFIRM] with the payer and when to follow up. The clinical justification must come from the treating provider; this prompt only organizes the documentation.