Have you had your organization's approved AI draft an appeal letter?

AI can draft a clear appeal that answers the payer's criteria one by one. Use only the BAA-covered tool your organization approves, and check every fact.

How to automate it

How to automate “do prior authorizations”

Here are 2 ways to spend less time on this, best first. Each comes with steps you can follow today and, for AI fixes, a prompt to copy.

45 min

typically, every day

50%

of the time can be automated

Some setup

to set up

Fix 1 of 2

Software featureBest fix

Submit prior authorizations electronically from the EHR

Electronic prior authorization pulls the patient and clinical details from the chart, shows the payer's questions, and often returns an answer in minutes. New federal payer rules are making this more common through 2026 and 2027.

Typically saves about 40% of the time1 h to set up

1Ask which ePA tools are connected to your EHR (CoverMyMeds or Surescripts for drugs; Availity, Cohere or your EHR's payer platform for services).
2Start the request from the order in the EHR instead of a fax form.
3Save templates for your most common requests.
4Track pending requests in one work queue instead of a spreadsheet.
5Only use tools your organization has approved and covered by a HIPAA business associate agreement (BAA) for anything with patient information.

Tools: CoverMyMeds · Surescripts · Availity · Cohere Health · Epic Payer Platform

Fix 2 of 2

Have approved AI draft the appeal or letter of medical necessity

AI drafts a clear, well-structured appeal from the denial reason, the policy and the clinical facts. You check every fact and sign. Use only your organization's BAA-covered AI for anything with patient details.

Typically saves about 45% of the time10 min to set up

1Gather the denial letter, the payer policy and the key clinical facts.
2Use only your organization's approved, BAA-covered AI tool. If you do not have one, remove all patient identifiers first.
3Use the prompt below.
4Check every clinical fact and code before sending.

Prompt to copy

Draft an appeal letter for a denied [SERVICE / MEDICATION]. Denial reason: [PASTE REASON]. Payer policy criteria: [PASTE POLICY TEXT]. Clinical facts: [DIAGNOSIS, HISTORY, TREATMENTS TRIED AND RESULTS, WHY THIS IS NEEDED NOW]. Address each policy criterion one by one with the matching fact. Keep it under one page, professional and factual. Mark any criterion without supporting facts as [MISSING]. Do not invent clinical details.

Tools: Your organization's approved, BAA-covered AI assistant

Quick wins

Have you tried…

Do you submit prior authorizations electronically from the EHR instead of by fax?: Electronic prior authorization fills in the patient details from the chart and often gets an answer in minutes. Tools include CoverMyMeds and payer platforms linked to your EHR.
Have you had your organization's approved AI draft an appeal letter?: AI can draft a clear appeal that answers the payer's criteria one by one. Use only the BAA-covered tool your organization approves, and check every fact.

Who does this task

Roles in our library that list this as one of their common tasks. Each guide covers the rest of that role’s week.

Nurse Medical assistant / front desk Medical billing / coding specialist Physician / clinician Pharmacy technician

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