Prior authorization letters written from the visit itself

When a test, procedure or medicine needs the insurer's approval, the justification usually gets written at the end of the day, from memory. ClearPass writes it from the same conversation it used for the note, with ICD-10 diagnosis codes and procedure codes, then reads it back the way a reviewer would before you file it.

How it works

1. Transcribe the visit, or type or paste the note you already have. You can add a photo of a lab or radiology report; remove patient identifiers first, as images are not auto-redacted.
2. Ask for the justification. If something a reviewer would look for is missing, ClearPass asks you before it writes, because a letter with a gap in it is the one that comes back. You can switch the questions off and get the gaps listed instead.
3. Pick the length. Concise for a short portal field, Standard for most requests, Detailed when the case is complex or has been refused before.
4. Check it and file it. ClearPass tells you what is still missing, such as no onset date, a severity with nothing to back it, or a treatment tried with no dates. Copy the letter and codes into your portal or EMR.

What a reviewer reads for

Most prior authorization reviews follow the same logic whatever the service. The reviewer wants to know that the diagnosis is established, that the requested item is the reasonable next step for that diagnosis, and that cheaper or safer options were tried first or are clearly unsuitable. They read quickly and they read against a checklist.

• A diagnosis supported by findings, not just a label: examination signs, test values, imaging reports.
• What was tried before, with names, doses or sessions, dates and how long each lasted.
• Why it failed or was stopped: no response, partial response, side effects, contraindication.
• How the condition affects the patient now: pain scores, function, work, sleep, validated scales where they exist.
• Red flags or risk that make waiting unsafe, stated plainly if they are present.
• What the result of the requested service will change in management.

Guideline criteria for a given service usually map onto these same points. A letter that answers each one in order is easier to approve than a longer letter that answers half of them well.

A structure that holds up

ClearPass writes the letter in a fixed order so the reviewer finds each answer where they expect it: the request and codes first, then the clinical summary, the treatment history, current severity and function, the reason for this service now, and a closing line that states what is being asked for.

Request: MRI lumbar spine without contrast (72148).
Diagnosis: Radiculopathy, lumbar region (M54.16).

[Patient initials], 46, has had left leg pain in an L5 distribution for 9 weeks with numbness over the dorsum of the foot. Examination today shows reduced great toe extension power (4/5) and a positive straight leg raise at 40 degrees on the left.

Conservative treatment: supervised physiotherapy for 6 weeks (12 sessions) and regular oral analgesia with an NSAID for 8 weeks. Pain remains 7/10 and walking tolerance has fallen to about 10 minutes.

The persistent motor deficit after 6 weeks of treatment makes imaging the appropriate next step to assess for nerve root compression and plan an injection or surgical opinion.

How payer rules are used

Where we hold your country's rules pack, the letter is written against your payer's published criteria and quotes the reference. Where we do not, it argues the clinical case: what was tried, what failed, what the findings are and why this is the right next step. It never invents a payer, scheme or rule number.

Clinicians who file prior authorization requests and would rather not write them twice are the people this is built for. It covers more than 150 specialties. For service-specific guidance see MRI requests, biologic medicines and joint replacement. If a request has already been refused, see answering an insurance denial.

What ClearPass does not do

• It does not replace your judgement. Every note is an AI draft that you review and correct before it is used.
• It is not a medical device and does not make clinical decisions. It is a documentation aid.
• It does not connect to your EMR. The note is copy-ready text that pastes into any system.
• It does not submit anything to an insurer. You review the letter and file it yourself.
• It does not promise approval. It makes the case as strongly as the clinical facts allow.
• It does not invent clinical facts. If a fact is missing, it asks or lists the gap.

Privacy

Clinical note content is not stored on ClearPass servers: it is processed to write the note, then discarded. Consultation audio is transcribed and discarded, never stored. Your note history stays in your browser, on your device, and you choose how long it is kept. Common identifiers are removed from typed and transcribed text before it reaches the AI; that is a best-effort safeguard, so leave names, ID numbers and file numbers out where you can. Processing goes through the AI providers named in our Privacy Policy, which sets out exactly what each one receives and how long it keeps it. ClearPass does not sign HIPAA business associate agreements today.

Questions

Related

• Answer an insurance denial with the criterion it failed
• How to write a letter of medical necessity
• ICD-10 codes that support a prior authorization request
• Prior authorization for MRI: what the request needs