📋 Prior Authorization

3 / 518 min

📋Module 5 · Slide 17

Clinical Documentation Checklist

Every authorization submission needs specific documentation. Knowing this checklist helps you coach your referral sources to send complete packets the first time — which speeds everything up.

Required Documentation for Every Submission

Signed prescription from the treating physician

Patient demographics and insurance information

Recent history and physical examination

Relevant lab results (IgG levels for PI, EMG for CIDP, etc.)

Documentation of failed prior therapies (for biologics)

Certificate of Medical Necessity (for Medicare Part B)

State-specific forms signed by physician (for Medi-Cal)

Strong clinical justification if step therapy not completed

⭐ Pro Tip: Train the Office Staff

The physician's office staff are the ones who actually pull the records. Train them on exactly what you need for specific therapies. When they know the checklist by heart, your authorization approvals get faster and your referral relationship gets stronger.