Prior authorization request checklist

Review the inputs to confirm before submitting a prior authorization request, so it is complete the first time.

Updated July 18, 2026

Use this session-only checklist to structure a prior authorization request before submission. It does not confirm whether a specific service requires authorization or what a specific payer needs — the payer's current policy remains the controlling source.

Progress

0 of 9 reviewed

The requirement was confirmed against the current payer policyVerify that this service requires authorization for this plan today, using the payer's own current policy rather than a general assumption.Coverage is active for the date the service is plannedConfirm eligibility for the planned service date; an authorization does not help if coverage is not active when the service is delivered.The correct payer, submission channel, and any required form are identifiedConfirm which entity reviews the request — the plan, a delegated benefit manager, or a review organization — and the channel and form it requires.The requested service, units, and planned dates are specifiedState the specific service, the number of units or visits, and the date or date range so the approval can be matched to the eventual claim.The ordering and rendering provider identifiers are correctRecord the correct provider identifiers for the request so the approval is tied to the provider who will deliver and bill the service.Clinical documentation supporting medical necessity is attachedInclude the record that establishes why the service is appropriate for the patient's condition, drawn from the chart — never created to fit a criterion.Any step-therapy or specific coverage criteria are addressedWhere the plan applies step therapy or specific criteria, document the prior trials or the basis for an exception before submitting.The correct standard or expedited pathway is selectedWhere the clinical situation is urgent, use the payer's expedited pathway and its stated requirements rather than the standard route.The submission is recorded with its date and referenceCapture the submission date, channel, and any confirmation or reference number in the secured system so the request can be tracked to a decision.

Use this checklist safely

Your selections remain only in this browser tab and are cleared when you reset or leave. Do not enter patient information here.

Related Knowledge

Prior authorization
What the requirement is and where it sits in the cycle.
How to obtain a prior authorization
Prior authorization request tracker

Prior authorization request checklist

Related Knowledge

Referenced in the Knowledge Base

Submitting a prior authorization request

Ready to improve your revenue cycle?