Generate Prior Authorization Letter
get_prior_auth_letterRead-only
Generate a payer-ready prior-authorization letter for a procedure by merging patient details, CPT codes, ICD-10, and necessity rationale; leaves unspecified fields as fill-in blanks.
Instructions
Generates a formal, payer-ready prior-authorization / medical-necessity letter for a procedure, merging supplied patient and clinical details with the procedure’s CPT codes, recommended primary ICD-10 code, evidence grade, and necessity rationale. Any field left unspecified is rendered as a clearly-marked fill-in blank. The structured medical-necessity worksheet is appended when available. PREMIUM tier.
Input Schema
TableJSON Schema
| Name | Required | Description | Default |
|---|---|---|---|
| icd10 | No | Primary ICD-10 code; defaults to the recommended primary code. | |
| payer | No | Payer / insurance company name. | |
| memberId | No | Insurance member / Medicare beneficiary ID. | |
| diagnosis | No | Primary diagnosis narrative (e.g. "left L5 radiculopathy"). | |
| painScore | No | Pain score, e.g. "7/10 at rest, 9/10 with activity". | |
| procedure | Yes | Procedure name, id, or CPT code. | |
| patientDOB | No | Patient date of birth. | |
| patientName | No | Patient full name. | |
| providerNPI | No | Ordering provider NPI. | |
| providerName | No | Ordering provider name and credentials. | |
| imagingFindings | No | Relevant MRI/CT/X-ray findings with date. | |
| symptomDuration | No | Symptom duration, e.g. "5 months". | |
| conservativeCare | No | Failed conservative care with durations, e.g. "8 weeks PT, NSAIDs x6 weeks". | |
| includeWorksheet | No | Append the structured medical-necessity worksheet template (default true). | |
| functionalLimitations | No | Functional limitations narrative. |