Guide · 02
Prior Auth Prep Checklist
The 18 items we run on every CliniLoom-prepared PA packet. Use it as-is, or let CliniLoom run it for you.
00The 18-point checklist
- 01Verify patient demographics and insurance subscriber match payer recordAuto
- 02Confirm CPT and ICD-10 codes for the requested serviceAuto
- 03Pull payer-specific medical policy in effect todayAuto
- 04Document conservative therapy attempted, with dates and outcomesAuto
- 05Attach failed-therapy attestation if requiredAuto
- 06Include relevant imaging, labs, and procedure reportsAuto
- 07Note any contraindications to lower-tier alternativesAuto
- 08Pull most recent specialist consult or PCP referralAuto
- 09Add patient-reported functional impact (in clinical terms)Auto
- 10Confirm in-network status for ordering providerAuto
- 11Confirm in-network status for performing facilityAuto
- 12Verify member benefit category covers the serviceAuto
- 13Check existing accumulator (deductible, OOP) for cost-of-care contextAuto
- 14Draft cover letter / medical necessity in payer's expected formatAuto
- 15Spellcheck patient and provider names against EHR exactlyAuto
- 16Identify missing items and assign to the right ownerAuto
- 17Route to clinician for sign-off — never auto-submitAuto
- 18Log submission with payer reference number for audit trailAuto
CliniLoom runs items 1–17 automatically and surfaces what's missing. Your clinician handles item 17 (sign-off). Item 18 is logged for you.
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