Prior authorization appeal tool

Prior authorization requires providers to obtain advance approval before performing a service to qualify for payment coverage. Prior authorization for medications usually involve brand-name products for which there is no generic equivalent, or a drug that a patient has taken for years but for which the insurance carrier now requires annual re-authorization.

The Academy has created a customizable, clinically specific tool to allow your practice to easily download prior authorization appeal letters for select dermatologic drugs and diseases.

Create an appeal letter using the tool below.

Step {{index}} of {{steps.length-1}}

Prior Authorization Drug Denial Letter Template

Complete the following steps to create an individualized letter appealing a denial for a prescribed treatment for your patient.

Dermatologic disease with ICD-10 diagnosis code

Name of drug

Alternative Treatment Drug Options

For step therapy protocols, select drug/treatment the insurance company is requiring you to prescribe your patient as an alternative treament (skip if not applicable)

Back

Patient name

Patient health insurance identification number

Patient date of birth

Date of prior authorization

Back

I have previously prescribed this patient the following therapies (optional):

Prescribed from {{ convertDatePickerDate(medication.startDate) }} to {{ convertDatePickerDate(medication.endDate) }}

Reasoning: {{ medication.stopReason }}

Name of medication

Dates prescribed

From

Reason for stopping medication

Back

Click the button below to download your prior-authorization letter template.

Download Letter

Oh no! Something has gone wrong on our end. Please try again later.

Back

Prior authorization resource center