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Draft prior auth letters and LMNs
Paste the clinical notes and the request, and get a letter of medical necessity, portal answers or a checklist built from the chart.
Paste the clinician's notes and what you are requesting, and River drafts a letter of medical necessity, answers for the plan's portal questions, or a checklist of what to submit. The letter is built from the chart: the diagnosis, the findings that matter, what has been tried with dates and doses, and why the requested service is needed now. Anything the notes do not show is marked for the clinician instead of filled in.
Plans review requests against written criteria, so the strongest letter answers those criteria in the plan's own words. If you have the plan's policy, paste it and each criterion becomes a numbered point. Without it, River writes to the usual elements: severity, duration, prior treatments and their outcomes, and functional impact. For a criterion-by-criterion map with an evidence table, the medical necessity letter on meetriver.com goes further.
Writing prior auth documentation that holds up
Answer the plan's criteria, not a generic idea of necessity. If the policy requires two prior formulary alternatives, list exactly which drugs were tried, at what doses, between which dates, and why each was stopped: inadequate response, side effect or contraindication. Reviewers check those details against the policy one by one.
Ask for expedited review only when the clinician judges that waiting could seriously jeopardize the patient's life, health or ability to regain function, and say why in one plain sentence. For Medicare Advantage and Medicaid plans, federal rules now require decisions on most non-drug requests within 72 hours for expedited cases and seven calendar days for standard ones.
If the request is denied, appeal the stated reason directly; the prior authorization appeal tool drafts that letter.
How it works
Paste the notes
The clinician's notes, results and medication history, plus the plan's policy if you have it.
Name the request
The medication, test, device or procedure, and the plan you are sending it to.
Get the draft
A letter, portal answers or checklist built from the chart, with gaps marked.
Review and sign
The clinician checks every statement, fills the marked gaps, signs and submits.
What you get
- A letter of medical necessity in formal business letter format, ready for the clinician to sign
- Short answers to the plan's portal questions, each answering only what was asked
- A checklist of documents and details to submit with the request
- A prior treatments table with drug or therapy, dose, dates, outcome and reason stopped
- Gaps in the chart marked for the clinician, never filled with guesses
Common questions
Can I paste the plan's coverage criteria?
Yes, and it is the most useful thing you can add. Each criterion becomes a numbered point in the letter, answered from the chart or marked as not shown in the notes, so the clinician can see what is missing before the request goes in.
Does this work for Medicare coverage determinations?
Yes. If a national or local coverage determination applies, name it or paste its indications, and the letter answers those indications. For Medicare Advantage plans, the plan's own criteria apply only where Medicare's rules leave the question open, so start from the coverage determination when one exists.
Will it add guidelines or studies?
Only real ones. River cites guidelines or studies the clinician supplies, or ones it finds and can link, and lists them so they can be checked. It never invents a reference.
Can I include patient identifiers?
Follow your organization's policy. River is HIPAA-eligible and offers a Business Associate Agreement for work with identifiable information. Without one, use placeholders for the name, date of birth and member number and fill them in your own system.
Draft prior auth letters and LMNs
Describe what you need, add any files you have, and your workspace opens with the work already underway.