For Registered Nurses ·
What you'll accomplish
By the end of this guide, you'll be able to use Claude to draft comprehensive, well-organized prior authorization documentation packages for home health, DME (durable medical equipment), and skilled nursing facility placement — cutting the time you spend on this frustrating task by 50% or more, while producing cleaner documentation that gets approved faster.
What you'll need
Before asking Claude for help, know clearly:
Common prior auth requests nurses help document: home health nursing visits, home physical therapy, home oxygen (O2 sat criteria), power wheelchair/scooter, hospital bed, wound care supplies, continuous tube feeding, home IV antibiotics, SNF placement.
Write down the key clinical facts in bullet points. This is what you'll give Claude. Remove all patient identifiers:
Example notes:
Type this prompt (with your de-identified clinical facts):
"Write a prior authorization clinical necessity narrative for home health skilled nursing services. This patient has: [paste your bullet points]. The request is for [X] skilled nursing visits per week for [X] weeks. Make the case for medical necessity, highlight the skilled care needs, and explain why skilled supervision is required rather than just family or patient self-management."
Claude will give you a structured narrative. Review it and ask for improvements:
After drafting a few authorization narratives, ask Claude to generalize them into reusable templates:
"Create a template for a home health prior auth narrative for CHF patients being discharged with heart failure management needs. Use [BRACKETS] for the parts I'll customize for each patient."
Save this template in your phone's notes app. Next time, you just fill in the brackets.
Home health nursing: "Write a prior auth narrative for home health skilled nursing visits for a patient with [diagnosis] being discharged with [specific needs]. Requesting [X] visits/week for [X] weeks."
Home oxygen: "Write a prior auth narrative for home oxygen for a patient with [pulmonary diagnosis]. Qualifying O2 sat: [value on [L/min NC at rest/exertion]. Requesting [X LPM] continuous/nocturnal/exertion."
DME — hospital bed: "Write a prior auth narrative for a hospital bed for a patient with [diagnosis and functional limitations]. Focus on: skin integrity risk, caregiver burden, safety concerns."
SNF placement: "Write a prior auth narrative for skilled nursing facility placement for a patient with [diagnosis] who needs [specific skilled services] that cannot be provided at home because [reasons]."