Using Prior Auth
Generating a packet
With clinical context in place, Generate packet drafts the packet. It is a draft for your team to read and correct, not a finished document.
Before you generate
- The request is in Draft or Ready for review and has no packet yet.
- It has at least one clinical note or some structured findings. Uploads alone don't count.
- Your practice's billing and limits allow it. If not, you'll see why; see Troubleshooting.
What happens when you generate
- Prior Auth checks your practice's allowance first. If it's used up, nothing is generated.
- Patient identifiers are removed from your notes and the request details, and the result is checked again before anything leaves the app. If an identifier is still present, drafting stops and tells you.
- The sections appear one by one as they are written. It usually takes under a minute. Nothing is saved until the whole draft is complete.
- The draft is checked against the packet format, the patient's real details are put back in your copy, and it is saved.
Generating doesn't change the request's status. A request stays in Draft until you mark it ready.
What is in the packet
| Section | Fields |
|---|---|
| Clinical Justification | Summary, Medical necessity, Relevant history, Prior treatment, Expected outcome |
| Supporting Documentation Summary | Clinical notes, Structured findings, and a box titled Payer may expect, but not provided |
| Prior Auth Request Letter | Subject, Letter, Enclosures |
“Payer may expect, but not provided”
This box lists items that payers commonly ask for in a case like yours and that your notes don't include, such as an X-ray or a periodontal chart. It is a prompt to check, not a requirement. Add what you have to the context or the notes, or mention it in the letter.
Cancelling and failures
- Cancel stops the draft. Nothing is saved and you can generate again.
- If the connection drops or the answer comes back unusable, nothing is saved and Try again appears.
- Every attempt, including failed ones, is recorded without its content, and tokens an attempt used can count toward your monthly allowance.
- Only one draft can run per request at a time, even across browser tabs.
Read it before you rely on it
The draft can only restate what you gave it, and it can still be wrong, vague or too confident. Check every claim against the chart, in particular dates, measurements and codes. You're responsible for what is submitted.