Workflow · Prior Authorization Prep
The PA packet, mostly written before you sit down.
CliniLoom pulls payer requirements, builds the packet from the chart, drafts the medical necessity letter, and tells you exactly what's missing. You attach the last detail and submit.
INWhat CliniLoom reads
- Order or referral
- Payer-specific requirements
- Chart history, prior treatments, imaging
- Lab and procedure results
OUTWhat CliniLoom prepares
- Per-payer checklist (what's needed, what's present)
- Drafted cover letter / medical necessity
- Missing-evidence list with where to find it
- Submission-ready packet for clinician review
FLOWStep by step
01 · SYSTEM
Order / referral created
02 · AI
Pull payer requirements
03 · AI
Assemble evidence from chart
04 · AI
Draft cover letter
05 · AI
Surface missing items
06 · STAFF
Clinician approves + submits
EXReviewable example
AI · drafted · medium confidenceSource: PA case #PA-2204
Continuous glucose monitor · Anthem
Type 2 DM with insulin therapy documented (12 mo). Last A1c 8.4. Drafted necessity citing hypoglycemia events and titration goals. Missing: most recent CGM trial outcome note.
ApproveEditEscalate
SAFEGuardrails
- Nothing is submitted to the payer until a clinician signs off.
- Every claim in the drafted letter is anchored to a chart source.
- Payer rules are referenced, not invented — outdated rules are flagged for review.
In CliniLoom
Prior Auth
The module where this workflow lives in your CliniLoom workspace.