RxCheckUp Blog
Evidence-based guides for prior authorization, Letters of Medical Necessity, and specialty drug access.
How to Write a Letter of Medical Necessity in 2026 (7-Part Template)
Step-by-step LMN template with the 7 sections payers look for, payer-specific language that wins, and the 6 mistakes that cause 80% of denials.
Top 10 Prior Authorization Denial Reasons in 2026 (How to Beat Each)
Only 10% of PA denials get appealed but 50%+ of appeals succeed. The 10 most common denial reasons and the clinical language that flips each.
Specialty Drug Prior Authorization 2026: Clinician Guide to First-Pass Approvals
CMS mandates, ePA deadlines, and new payer policies reshape specialty PA in 2026. What changed, what it means for approvals, and how to adapt.
How to Appeal an Insurance Denial in 2026: 6-Step Playbook
Appeal success rates hit 55%+ with this 6-step framework. Timelines, peer-to-peer tactics, and documentation language that overturns denials.
GLP-1 Prior Authorization Requirements 2026: Ozempic, Wegovy & Mounjaro
2026 PA criteria for Ozempic, Wegovy, Mounjaro & Zepbound by payer. BMI thresholds, step therapy requirements, failed-drug documentation, and free LMN templates.
Medicare Part D Coverage Determinations: A Clinician's Guide (2026)
How Medicare Part D coverage determinations work in 2026: exception requests, tiering exceptions, and appeals for denied medications.
How to Appeal a Step Therapy Denial: A Clinician's Playbook (2026)
A clinician playbook for step therapy denials: how to document medical necessity exceptions, common drugs affected, and sample appeal language.
Biologics Prior Authorization 2026: Step Therapy, Criteria & Appeal Templates
PA criteria for TNF inhibitors, IL-17, IL-23, JAK inhibitors & asthma biologics. Step therapy requirements, required labs, and payer-specific LMN templates for rheumatology, derm & GI.
Understanding Insurance Formulary Tiers and PA Requirements (2026)
How insurance formulary tiers work, what preferred vs non-preferred means for PA, and how to navigate tiering exceptions to cut patient costs.
AI Prior Authorization 2026: Faster Approvals & Fewer Denials
How AI cuts prior auth burden in 2026: automated LMN generation, payer policy matching, and predictive denial analytics. What it means for approval rates.
Medicare Part B vs Part D Prior Authorization 2026: Key Differences
Compare Medicare Part B and Part D prior auth in 2026: which drugs fall where, different workflows, appeal timelines, and CMS compliance rules.
Cigna Denial Appeal Letter: 5 Steps That Win 55% of Cases
The proven 5-step Cigna appeal framework for 2026: exact Coverage Policy numbers, fax lines, P2P scripts, and rebuttal language that overturns 55%+ of denials.
Express Scripts Denial Appeal: 7-Step PBM Playbook
The definitive 2026 Express Scripts appeal guide: exact ESI forms, fax numbers, timelines, and the proven 7-element rebuttal that wins most pharmacy denials.
Humana Prior Authorization Guide 2026: MCPs, Timelines & Appeal Strategy
Humana prior authorization requirements for 2026: Medical Coverage Policy numbers, Medicare Advantage timelines, step therapy criteria, peer-to-peer contacts, and how to appeal Humana denials.
Prior Authorization Criteria by Drug Class: What Payers Require in 2026
The universal structure of prior authorization criteria across payers, with drug-class rules for biologics, GLP-1s, oncology, and specialty drugs.
How to Appeal a Cigna Denial 2026: Forms, Timelines & Peer-to-Peer
Cigna appeal timely filing deadlines, reconsideration forms, Coverage Policy numbers, and peer-to-peer scripts. Step-by-step guide to overturn Cigna prior auth denials in 2026.
Formulary Exclusion vs Prior Authorization: 2026 Guide for Billing Teams
~85% of pharmacy denials are formulary exclusions, not PA denials. They need a different process. Here is how to tell them apart and win each.
Cigna Appeal Form 2026: Complete Filing Guide for Providers
Step-by-step guide to filing a Cigna appeal in 2026 — exact forms, addresses, timeframes, and clinical documentation that maximizes overturn rate.
Cigna Timely Filing Limit for Appeals 2026 — Deadlines by Plan Type
Exact Cigna appeal timely filing deadlines for 2026: commercial (180 days), Medicare Advantage (60 days), Express Scripts, and FEHB. Miss the window, lose the appeal.
Cigna Coverage Policy Lookup: Find the Right CP Number Fast
Cigna Coverage Policies (CPs) are the key to winning prior auth appeals. Here's exactly how to find the right CP number for any drug or procedure.
Prior Authorization Phone Numbers by Payer: 2026 Master Directory
The 2026 directory of verified PA phone numbers: every major commercial carrier, 26 BCBS affiliates, PBMs, and Medicare Advantage plans.
GLP-1 Off-Label Coverage 2026: MASH and Sleep Apnea Battles
2026 GLP-1 coverage guide for off-label MASH and obstructive sleep apnea indications. Real Zepbound OSA approval impact, formulary exclusions, and exception strategies.
Biosimilar Selection Guide 2026: Which One Does Your Plan Prefer?
Which adalimumab, infliximab, and ustekinumab biosimilars are preferred by UnitedHealthcare, Aetna, Cigna, and major BCBS plans in 2026.
UnitedHealthcare Prior Authorization Guide 2026: Policies, Timelines & Appeals
UnitedHealthcare prior authorization requirements, OptumRx formulary policies, clinical coverage criteria, peer-to-peer contact numbers, and appeal strategies for 2026.
Aetna Prior Authorization Guide 2026: Clinical Policy Bulletins, Timelines & Appeals
Aetna CPB numbers, prior authorization submission steps, step therapy requirements, peer-to-peer contacts, and appeal strategies for specialty drugs in 2026.
Prior Authorization for Cancer Drugs: Oncology PA Guide 2026
How oncology prior authorization works in 2026 — NCCN criteria, biomarker requirements, checkpoint inhibitor PA, CAR-T approval pathways, and appeal strategies for cancer drug denials.
Elevance Health / Anthem Prior Authorization Guide 2026: Policies, Timelines & Appeals
Elevance Health (Anthem) prior authorization requirements for 2026: Clinical UM Guidelines, IngenioRx pharmacy criteria, Medical Policy numbers, step therapy by drug class, peer-to-peer contacts, and appeal strategy for commercial and Medicare Advantage plans.