# Prepare a prior authorization request that gets approved first time

Matches the payer's coverage criteria to the documentation you have, finds gaps before submission, and drafts the request and peer-to-peer prep notes.

- Topic: Projects & Operations
- Framework: RTF
- Level: Standard
- Tags: Writing, Analyze, Plan, Fill-in Template
- Source: https://www.thinkwithprompt.com/prompts/prepare-a-prior-authorization-request-that-gets-approved-first-time

## Prompt

```text
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.
```

## What to fill in

- e.g. "Medicare Advantage HMO", "state Medicaid MCO"
- ICD-10
- PASTE the medical policy or criteria checklist
- portal, fax, electronic PA
- PROVIDER TO CONFIRM
- CONFIRM

Free to copy and use. From ThinkWithPrompt (https://www.thinkwithprompt.com/), a library of 2,663 curated AI prompts.