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PA-2025-001

Archive Case

Archive Case

Case Progress

Patient Information

Provider Information

Device/Service Details

Clinical Information

Policy Review

Quality Assurance

Letter of Medical Necessity

Review & Submit

Case Progress

Patient Information

Provider Information

Device/Service Details

Clinical Information

Policy Review

Quality Assurance

Letter of Medical Necessity

Review & Submit

Quality Assurance

Step 6 of 8

Complete the quality assurance checklist to ensure your prior authorization submission meets all requirements. Critical items must be checked before submission.

Insurance Coverage

Critical

Insurance coverage and benefits confirmed

Billing codes validated

Critical

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HCPCS/CPT and ICD-10 codes are accurate and appropriate

Payer policy requirements confirmed

Critical

Current payer policies reviewed and requirements understood

Letter of Medical Necessity attached

Critical

LOMN generated and includes all required clinical justification

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Clinical evidence attached

Critical

Supporting clinical documentation uploaded and reviewed

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Place of Service rules met

Critical

Service location requirements satisfy payer policies

Package conforms to standards

Critical

Complete submission package meets all formatting requirements

Internal QA review complete

Critical

Final internal quality assurance review performed

Continue to letter of medical necessity

Continue to letter of medical necessity