Specialty Prior Authorization and Denial Guides

Specialty-specific billing guides covering prior authorization documentation requirements, payer-specific denial patterns, and appeal frameworks for 30 medical specialties. Each guide is verified against primary payer policy sources — Aetna Clinical Policy Bulletins, UHC Coverage Determination Guidelines, Cigna Medical Coverage Policies, and CMS Local and National Coverage Determinations — with CPB numbers, CDG names, and LCD identifiers cited inline.

Guides are organized by specialty and cover three commercial payers (Aetna, UHC, Cigna) plus Medicare. Each guide includes a prior authorization checklist identifying exactly which documents each payer requires for authorization of the relevant procedures, a denial pathway decision tree for the most common CARC codes in that specialty, payer-specific appeal strategies with the applicable regulatory citation and statutory basis, and a link to the Appeal Letter Builder pre-populated for that specialty and payer combination.