For ASC Coordinators ·
What you'll accomplish
By the end of this guide, you'll know how to use Claude to read through lengthy insurance clinical policy documents and extract exactly the information you need — in plain English, in under 5 minutes — so you can submit prior authorization requests that hit every required criterion the first time.
What you'll need
What you should see: The Claude interface — a clean conversation window with a text input at the bottom.
Most major insurance companies publish their clinical coverage policies online. Here's how to find them:
Anthem/BlueCross: anthem.com → providers → clinical resources → medical policies Aetna: aetna.com → health care professionals → clinical policy bulletins Cigna: cigna.com → health care providers → coverage policies UnitedHealthcare: unitedhealthcareonline.com → policies → coverage policies Humana: humana.com → providers → prior authorizations → clinical guidelines
Search the policy page for the procedure name or CPT code. Download the PDF. These documents are often 15–40 pages long.
What you should see: A PDF with the insurance company's specific criteria for covering this procedure.
Open the PDF. Use Ctrl+A (Windows) or Cmd+A (Mac) to select all text, then Ctrl+C to copy. If the PDF is very long, copy just the "Coverage Criteria" or "Medical Necessity Criteria" sections — those are the critical pages.
Go to your Claude conversation. Type:
"I'm going to paste an insurance company's clinical coverage policy. After I paste it, I'll ask you specific questions about what's required for prior authorization approval. Here is the policy:"
Press Enter, then paste the policy text. Wait for Claude to acknowledge it.
What you should see: Claude confirms it has received the document and is ready for your questions.
Now ask exactly what you need to know:
"Based on this policy, answer these questions: 1. What are the specific medical necessity criteria that must be met for this procedure to be covered? 2. What documentation must I include in the prior authorization request? 3. What diagnoses or conditions are excluded from coverage? 4. What prior treatments must be documented as having failed? 5. Is there a step therapy requirement (must try other treatments first)? 6. What is the appeals process if the request is denied?"
What you should see: A structured, plain-English summary answering each of your questions directly.
Copy Claude's response into a Google Doc or your notes. Title it "[Insurance Company] - [Procedure Name] - Coverage Requirements" and save it to your shared template folder.
Next time you submit a case for the same procedure with the same payer, you have a ready reference — no more re-reading the 40-page policy.
Troubleshooting: If Claude says the document is too long, paste just the "Indications and Limitations" section rather than the entire policy — that section contains the criteria you need.
For any new procedure + payer combination:
Based on this policy, what are the exact criteria I must document to get [procedure] approved with this insurance company? Give me a checklist format.
When you've had repeated denials:
We've had three denials for [procedure] from this payer recently. Based on this policy, what are we likely missing in our authorization requests?
For understanding appeal rights:
Based on this policy, what is the appeal process for denied authorizations? What are the time limits? What should I include in an appeal?
For comparing two policies:
Here is [Payer A]'s policy. [Paste it.] Now here is [Payer B]'s policy. [Paste it.] Compare them: where do the criteria differ? Which one is more restrictive?