Prior-authorization checklist for psychiatry
A checklist for getting a psychiatric medication or service through a payer's prior-authorization process, and for appealing a denial, with less back-and-forth.
What it is
A checklist for getting a psychiatric medication or service through a payer's prior-authorization process, and for appealing a denial, with less back-and-forth.
Who it's for
Prescribing clinicians and the staff who handle authorizations and appeals.
When to use it
When a payer requires prior authorization for a medication, a dose or quantity, or a service, and when a request is denied.
The checklist
Before you submit
- Confirm the plan actually requires prior authorization for this drug, dose, or service, and find the plan's specific form and criteria.
- Gather the clinical basis: diagnosis, tried-and-failed alternatives, contraindications, and why this choice fits the plan's criteria.
- Note any step-therapy or quantity-limit rules and whether an exception applies.
A clean submission
- Match your documentation to the plan's stated medical-necessity criteria, point by point.
- Include prior trials with dates, doses, and outcomes, and relevant labs or measures.
- Send it through the plan's preferred channel and record the reference number and date.
If it's denied
- Read the denial for the exact reason and the appeal deadline.
- Request a peer-to-peer review with a plan physician when that's an option.
- File a written appeal that answers the stated reason directly, and escalate to an external or independent review if the plan allows it.
Track and learn
- Log each request, its status, and its outcome so patterns are visible.
- Note which drugs and plans reliably need authorization so you can prepare up front.
- Tell the patient what to expect and about any interim supply.
Important limitations
Prior-authorization rules, forms, timelines, and appeal rights differ by plan and by state, and many states have passed prior-authorization reform laws that change deadlines or add gold-carding. Medicaid, Medicare Advantage, and commercial plans each work differently. Confirm the current rules for the specific plan and your state.
Sources
- American Medical Association, prior authorization practice resources. https://www.ama-assn.org/practice-management/prior-authorization
Reviewed by Shariq Refai, MD, MBA, FAPA, a board-certified psychiatrist. Last reviewed July 29, 2026.
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Badge text: From the Shrinkiatry practice resource library