For Occupational Therapists ·
What you'll accomplish
By the end of this guide, you'll have a library of reusable prior authorization letter templates in Claude — one for each of your most common insurance situations (Medicare, Medicaid, common commercial payers). When an auth is due, you fill in the blanks and have a complete clinical letter in under 5 minutes instead of 30–45 minutes.
What you'll need
What you should see: The Claude interface — a clean chat window with a text input at the bottom.
Start a new conversation. Paste this prompt exactly:
I am an occupational therapist. I need to create a reusable prior authorization letter template for Medicare Part B outpatient OT services.
The template should:
- Use medical necessity language that meets Medicare's skilled therapy criteria
- Include sections for: patient diagnosis (placeholder), functional deficits (placeholder), how services are restorative and not maintenance (specific language), frequency/duration requested, and therapist credentials
- Use [BRACKETS] for any information I'll fill in for each patient
- Be 1-2 pages when printed
- NOT include any real patient information
Please write the template now.
Claude will produce a full template with [DIAGNOSIS], [FUNCTIONAL DEFICITS], [REQUESTED FREQUENCY] and similar placeholders throughout.
Read the template. Add any modifications:
Each follow-up prompt refines the template until it matches what you'd actually send.
Now you have a reusable document. For each new auth, open the document, replace [BRACKETS] with patient-specific information, and you have a complete letter.
Repeat the process for each scenario you commonly face. Typical OT prior auth scenarios:
Commercial insurance — continued OT:
Build a prior auth template for commercial insurance requesting continued outpatient OT (10 more sessions). Patient has plateaued on one goal but still has significant deficits in [other ADL areas]. Use language that emphasizes ongoing skilled need and expected functional gains.
DME/Equipment justification:
Build a letter of medical necessity template for [type of equipment]. Must meet Medicaid/Medicare durable medical equipment criteria. Include sections for diagnosis, functional need, why alternatives are insufficient, and expected functional outcome.
Appeal after denial:
Build an appeal letter template for when OT services are denied as "not medically necessary." The template should directly challenge the criteria cited in the denial and request reconsideration with clinical evidence.
When you have a new prior auth to write:
Optional — use Claude for the final fill-in: Instead of manually replacing brackets, you can open Claude and paste:
"Here is my prior auth template: [paste template]. Fill in the brackets using this patient information: Diagnosis: [X]. Functional deficits: [list]. Sessions requested: [X]. Prior treatment: [Y]."
Claude fills in every bracket with clinically appropriate language.
Quick prior auth from bullet notes:
Write a prior authorization letter. Patient info: [diagnosis, deficits, treatment history]. Requested: [X sessions]. Payer: [insurance]. Medical necessity: [why skilled OT is required].
Denial appeal:
The payer denied OT citing [denial reason]. Write an appeal letter directly addressing their criteria. Clinical facts: [list]. Documentation of progress: [describe].
AT equipment justification:
Write a letter of medical necessity for [equipment]. Diagnosis: []. Functional limitations: []. Why less complex options are insufficient: []. Expected outcome: [].