--- title: "Providers can’t memorize every payer’s requirements - Davner" description: "No provider can memorize every payer’s rules. Procedure-specific checklists turn changing requirements into reliable documentation." canonical_url: "https://davner.com/blog/providers-cant-memorize-prior-auth-requirements" type: "article" published_at: "2026-06-25" updated_at: "2026-06-25" --- Source: https://davner.com/blog/providers-cant-memorize-prior-auth-requirements [Blog](https://davner.com/blog) # Providers can’t memorize every payer’s requirements No provider can memorize every payer’s rules. Procedure-specific checklists turn changing requirements into reliable documentation. Benjamin Lee, PhD — June 25, 2026 ![Red, black, and gray documents arranged in a stack.](https://davner.com/marketing/blog/providers-cant-memorize-prior-auth-requirements.fallback.png) Atul Gawande wrote a book called _The Checklist Manifesto: How to Get Things Right_. In it, he talks about how checklists have saved countless lives in medicine. He writes: > Here, then, is our situation at the start of the twenty-first century: We have accumulated stupendous know-how. We have put it in the hands of some of the most highly trained, highly skilled, and hardworking people in our society. And, with it, they have indeed accomplished extraordinary things. Nonetheless, that know-how is often unmanageable. Avoidable failures are common and persistent, not to mention demoralizing and frustrating, across many fields—from medicine to finance, business to government. And the reason is increasingly evident: the volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us. While the book talks about checklists in the delivery of medicine (for example, the steps in a surgery), the same is true in the administrative work around it. There are far too many payers and far too many procedures for any doctor to know every requirement. Doctors want what's best for their patients, and part of that means making sure they can access the care their doctor recommends. The best way to get prior authorizations approved is to ensure that the requirements have both been met and documented, and checklists enable exactly that. ## How to make a great prior auth checklist First of all, know there will be a lot of them. Each subspecialty and payer mix requires its own checklist. A spine surgeon who takes Cigna and BCBS Tennessee and a shoulder surgeon who takes United and Aetna are not going to be facing the same prior authorization documentation requirements. Here's the general process: 1. Identify the most frequent procedures the provider orders that require authorization. Better yet, figure out which ones have the most denials and delays. Davner does this automatically because we have the first-party data. 2. From there, track the requirements across payers and turn them into a step-by-step documentation checklist. If payers have different requirements, go with the stricter ones. It's easier to follow the same process every time than to figure out each patient's insurance before charting. 3. Use the exact language the payer wants to speed up review. Keep the checklist on a single page and make it readable from a distance. Post it wherever the provider dictates. It might not be possible to include every procedure, and that's okay. The 80/20 rule applies here: put the most frequent or troublesome procedures on the cheat sheet. ## Don't just rely on the payer guidelines There are two types of prior authorization requirements: explicit and implicit. Explicit requirements are published on payer websites. For example, one payer lists the following requirements for a rotator cuff MRI: > Advanced imaging is considered medically necessary for diagnosis of new or recurrent tear when ALL of the following apply: > > - Radiographs or ultrasound are nondiagnostic > - At least one positive sign to support the diagnosis of rotator cuff tear has been demonstrated > - EITHER of the following: > - At least one positive sign of a complete rotator cuff tear > - Failure of at least 6 weeks of conservative management Sounds easy, right? The problem is that the payer or its medical benefits management company asks different questions during submission. These are implicit requirements. The authorization questions still address the payer's stated guidelines, but charting that doesn't match the questions slows down both the submitter and the reviewer. That same payer _actually_ asks this when doing the authorization for a rotator cuff MRI: > Select all of the following evaluations that are documented to be positive. (Select all that apply) > > - Empty can (Jobe’s) or full can test (Neer’s) > - Hornblower's test (Patte) > - Infraspinatus muscle strength test > - External rotation lag sign > - Lift off test > - Belly press or belly off test > - None of these apply If the provider dictates a different test or doesn't specify which test was used, whoever's doing the authorization has to match the dictation to the available choices. If "None of these apply" is selected, the auth will of course be denied and require a peer-to-peer. A good checklist should explicitly show those options. How will you know what's actually asked during the authorization process? Keep track! Davner automatically keeps track of these questions, so it's easy for us to generate the checklist. Even if you're not using Davner, you can still do this by teaching your prior authorization staff to record the questions they're asked. ## The first checklist is just a start Payer requirements are always changing, so your checklist will need to change too. Some payers update their requirements monthly, so be sure to keep a date on your checklist. In aerospace, every time there's a plane crash, the National Transportation Safety Board does a thorough examination of what went wrong and recommends fixes to prevent it from happening again. If the accident could have been prevented with a checklist change, they'll recommend that the checklist be updated. The same thing should happen for your prior authorization checklists. Every time there's a preventable denial or delay, you should have a feedback loop by which the checklist can be updated to prevent it. ## Spend less time chasing prior authorizations Let Davner handle the work behind each approval, so your team can stay focused on patients. [Schedule demo](https://davner.com/book)