Prior Authorization SOPs (TMS / Ketamine / Med Mgmt)

What it usually contains

• Payer-by-payer authorization requirements and required clinical criteria (failed medication trials, diagnosis codes, symptom scores)
• Step-by-step submission instructions, forms, portals, and fax details
• Documentation checklists and required chart notes from the prescriber
• Turnaround time expectations, follow-up cadence, and tracking logs
• Denial, peer-to-peer review, and appeal procedures
• Rules for re-authorization, continued treatment, and taper or maintenance sessions

What the assistant uses it for

Answer questions about what an insurer needs before approving TMS, ketamine, or medication management, who submits it, and how long it takes. Also use it to explain what to do when an authorization is denied or expires mid-treatment.

How it is versioned

A document of this type has exactly one current version at a time. Upload a revision and it becomes the version that counts — the one before it is kept and dated, but is no longer what your assistant answers from. Nothing is ever deleted, so you can always show what this document said on a given date.