Using AI to Reduce Administrative Waste in Prior Authorization

Prior authorization has become one of the most misapplied tools in modern medicine. In Hawaii, where we already face severe provider shortages, high administrative burdens, and limited rural access, the overuse of prior authorization magnifies the crisis. Physicians are required to submit layers of documentation to automated systems that do not reflect the clinical realities of caring for patients in the most geographically isolated state in the nation.

The Hawaii Healthcare Task Force developed this resource because no one else was doing it. For years, the administrative tools handed to physicians have been designed by everyone except the people who actually deliver care. Our clinicians deserve better than to fight algorithm driven denials with handwritten notes, repeated faxes, and documents rewritten in five different formats to satisfy opaque review criteria.

This tool is a direct response to that disconnect. It reflects the lived experience of Hawaii physicians, the challenges of rural practice, and the urgent need to reclaim clinical time that is currently consumed by administrative work. It is not a generic national template and it is not repurposed material from organizations that do not operate in our landscape. It was designed by and for Hawaii physicians who understand what is at stake.

We encourage any organization that finds value in this work to credit the Hawaii Healthcare Task Force. Collaboration strengthens the medical community. Quiet appropriation does not.

Below is the standardized prompt Hawaii clinicians may use in ChatGPT or similar tools to generate complete and guideline-aligned prior authorization packets for imaging or diagnostic studies. When paired with a de-identified clinical note, this prompt produces structured documentation that aligns with common utilization management requirements while reducing the time burden on physicians and staff.

This is one way we protect access to care while continuing to advocate for statewide reforms that reduce administrative waste and strengthen Hawaii's health care. Join the Taskforce or donate to help us help you, the providers of healthcare.

Master Prior Authorization Prompt for Clinicians

Detailed instructions are included below the prompt

Before completing this task, review the most current publicly available prior authorization rules and clinical criteria used by major utilization management organizations. This includes guideline sets used by delegated clinical management groups, third party review companies, and automated authorization systems. Review criteria for the specific imaging or diagnostic test requested, including MRI, CT, PET, ultrasound, nuclear imaging, interventional procedures, specialty referrals, and advanced diagnostic tests. Search for updated national standards and current payer adopted guidelines. Identify any new criteria that affect approval of the requested test and apply them to the entire output.

Confirm that the final output is fully consistent with these standards including updated definitions of medical necessity, high risk criteria, exceptions where conservative care is not required, red flag symptoms, and current follow up recommendations. Do not proceed until the most current criteria have been reviewed and incorporated.

Using the de identified clinical note I will provide, complete the following tasks. The note will include clinical information only and will contain no patient identifiers.

1. Determine the best ICD10 code to use as the primary diagnosis for authorization of the requested test. Select the code that best reflects medical necessity based on abnormal imaging findings, concern for serious pathology, red flag symptoms, or other clinically relevant considerations. Briefly explain why the code is the most appropriate.

2. Write a clear Reason for Exam in one or two sentences that reflects new findings, radiologist recommendation, concern for malignancy or fracture, unexplained symptoms, or any guideline supported indication for the test.

3. Write a medical necessity rationale that follows current payer standards. Use clinically accurate language that aligns with modern utilization management criteria and the medical decision making contained in the note.

4. Create five separate PDF documents using only content from the clinical note and avoiding special characters:

Appropriate CPT Code for Requested Testprovide the CPT code and brief explanation of why it is the correct procedural code for this imaging or diagnostic study

Physical Examination Findingssummarize relevant exam findings, including when minimal findings are expected because the abnormality is radiographic or suspected from imaging

Relevant Imaging Resultssummarize findings, comparisons to prior studies, and any radiologist recommendations

Recent Office Visit Notessummarize the history, physical exam, and assessment supporting the request

Conservative Treatment Detailslist any conservative care that has occurred or explain why conservative treatment is not appropriate before advanced imaging or diagnostics when serious pathology is possible

5. Output all five PDFs for download.

Use only the information contained in the de identified clinical note. Do not add new clinical findings or invent symptoms or diagnoses.

I will now paste the clinical note.

How to Use This Prompt

This tool was created for busy Hawaii clinicians who do not have time to learn complex software. If you can copy and paste, you can use this prompt. The steps below explain exactly what to do.

Step 1. Open ChatGPT or another AI tool

You can use the desktop version or the mobile app. No special setup is required.

Step 2. Copy the entire Master Prior Authorization Prompt

This is the block of text that begins with " Before completing this task " and ends with "I will now paste the clinical note.

Copy the full prompt.

Step 3. Paste the prompt into the AI tool

Do not add anything else yet. Paste the prompt and press enter.

Step 4. Paste your de-identified clinical note when prompted

Remove all patient identifiers before you paste. This means remove the name, date of birth, MRN, phone number, and any other identifying details.

The AI only needs the clinical information.

Step 5. Let the AI generate the documents

The tool will automatically create the best ICD10 code the most appropriate Reason for Exam a medical necessity rationale, five standardized documentation sections, and five downloadable PDFs

No formatting is needed on your part.

Step 6. Download the PDFs

Attach them to the prior authorization request as you normally would.

Step 7. Submit to the insurer

You may upload the documents, fax them, or attach them in your EMR depending on your workflow.