For Respiratory Therapists ·
What you'll accomplish
By the end of this guide, you'll be able to draft a complete, clinically appropriate prior authorization or appeal letter for home respiratory equipment — CPAP, BiPAP, home oxygen, nebulizers, or home ventilators — in 10–15 minutes instead of 45–60 minutes. Claude generates letters with the right clinical structure, qualifying criteria language, and payer-appropriate documentation.
What you'll need
HIPAA reminder: Do not include patient name, date of birth, SSN, or MRN in your Claude prompts. Use clinical data only (diagnosis, test values, equipment prescribed). Add patient-identifying information after downloading/printing the Claude output.
Before opening Claude, collect the key documentation. For the most common equipment types:
Home oxygen: SpO2 on room air (documented ambulatory or nocturnal), qualifying ABG values (PO2 ≤55 or SpO2 ≤88%), diagnosis, hospitalization history
CPAP/BiPAP: AHI from polysomnography or home sleep test, REM AHI if relevant, Epworth Sleepiness Scale score, diagnosis (OSA, UARS, OHS)
Home nebulizer: FEV1 % predicted (post-bronchodilator), diagnosis, failure of MDI therapy, documentation of exacerbations
Home ventilator: Ventilator settings, ABG on those settings, diagnosis, qualifying criteria (hypercapnia, neuromuscular disease, etc.)
Go to claude.ai, log in, and open a new conversation. Use this structure:
"Write a prior authorization letter for [equipment type] for a patient with [diagnosis]. Clinical documentation: [list your key values]. Insurance: [Medicare/Medicaid/payer name]. Include: clinical justification, documentation of qualifying criteria, requested equipment, treating physician information section, and signature block for physician signature."
Claude will generate a 300–500 word letter. Before using it:
For appeals, add the denial reason to your prompt:
"Write an appeal letter for a denied prior authorization for [equipment]. Denial reason: [payer's stated reason]. Clinical justification: [your data]. Insurance: [payer]. Include: restatement of medical necessity, specific response to the denial reason, request for expedited review, and attachments list."
CPAP authorization (Medicare):
Write a Medicare prior authorization letter for CPAP therapy. Patient has moderate-severe OSA: AHI [x] on attended polysomnography on [date], or AHI [x] on home sleep test. Epworth score: [x]. Diagnosis: G47.33. Requested equipment: CPAP device (E0601). Format per Medicare LCD for CPAP.
BiPAP for obesity hypoventilation:
Write a prior authorization letter for BiPAP-S for a patient with obesity hypoventilation syndrome. ABG: pH [x], PaCO2 [x], HCO3 [x], PaO2 [x] on room air. BMI [x]. Diagnosis: E66.01, G47.36. No prior CPAP trial (not clinically appropriate due to hypercapnia). Payer: [name].
Home nebulizer:
Write a letter of medical necessity for home nebulizer and [medication] for a patient with [diagnosis]. FEV1 [x]% predicted post-bronchodilator. Patient unable to coordinate MDI properly due to [reason]. [Number] hospitalizations in past 12 months. Payer: [name].
Appeal — CPAP denial:
Write an appeal letter responding to a denial of CPAP authorization. Denial reason: [payer's stated reason]. Restate medical necessity: AHI [x] documented on [test type] on [date]. Emphasize safety risk of untreated OSA including [relevant comorbidities]. Request expedited review.