AuthAssist PA

Guidance based on publicly available insurer policies (May 2026) — verify with insurer or UM vendor before submission. Not medical or legal advice.

Step 1 of 4 — Insurance & Service

Select insurance plan

Plan type

Service / procedure category

Specific procedure or medication

CPT / HCPCS code (optional)

Step 2 of 4 — Clinical Profile

Patient clinical profile

Sex

Height (for BMI)

Weight (lbs)

Primary diagnosis (ICD-10)

Comorbidities

Current symptoms

Pain Radiculopathy Weakness Numbness/Tingling Dyspnea Chest pain Limited ROM Functional loss Neuro deficit Myelopathy signs Cauda equina sx Hyperglycemia Fatigue

Symptom duration

Functional limitations

Comorbidities

T2 Diabetes Hypertension Obesity Sleep apnea Heart failure COPD/Asthma CKD Depression/Anxiety Active cancer Tobacco use ASCVD history Dyslipidemia Anticoagulation Immunosuppressed

Step 3 of 4 — Treatment History & Criteria

Prior treatments & step therapy

Treatments tried & documented in chart

Physical therapy Chiropractic NSAIDs Oral steroids Injections (ESI/CSI) DMARDs / MTX Prior biologic Supervised wt-loss pgm Psych evaluation Metformin trial Lifestyle modification Sleep study Cardiac clearance Dietitian eval

Duration of conservative treatment

Step therapy status

Completed labs & imaging

X-ray MRI completed CT completed EKG / EEG Echocardiogram CBC / CMP HbA1c Lipid panel RF / Anti-CCP ESR / CRP Pathology report TB screening DEXA scan EMG / NCS