From Charting to Approval

Nov 3, 2025

From Charting to Approval: Mastering Documentation for Faster Approvals and Better Outcomes

By Alisa Redmon

Dermatology bears high rates of prior authorization (PA) denials across specialties, making navigation of insurance criteria one of the most significant hurdles for practices. These challenges have made it more and more necessary for dedicated staff with the sole focus on PAs and patient access. As Biologic Coordinators, we all love the fight with the insurance companies and the gratification of getting approval. In order for us to have the advantage, we need the necessary documentation. Extensive charting and details of previous treatment outcomes directly affect PA determinations.

The fight starts with the prescriber

The burden of documentation rests on the prescriber, with the assistance of the medical assistants (MAs) or Dermatology Techs. Plan criteria varies by plan, by medication, and can change at any time of the year. As BCs, it is our responsibility to stay up-to-date with these changes and communicate them to the prescribers and clinical staff.

Each plan has its own criteria

For example: for Atopic Dermatitis, some plans may require an Eczema Area and Severity Index (EASI) score; while others require an (Investigator’s Global Assessment) IGA score. Because of this inconsistency, all assessments must be documented so as to satisfy any plan the patient may have.

Another example: Some plans still require a trial and failure of ‘conventional systemic’ treatments before the approval of an injectable. These conventional systemics include methotrexate, cyclosporine, acitretin, and are rarely used as a first line of treatment anymore due to their side effects and inefficacy in comparison to injectables. Unless the prescriber can document that the conventional systemics are contraindicated for the patient, we have to dig into the patient’s medical history to find a reason for contraindication.

Plans will change their criteria at any time

This presents particular challenges not only for documentation purposes, but for the patient. For the longest time, most plans accepted Body Surface Area (BSA) for Atopic Dermatitis. At one point that changed, and they no longer would accept BSA and rather required IGA, EASI, or Scoring Atopic Dermatitis (SCORAD). Prescribers were not used to measuring these assessments, so not only was it a change in habit but a learning curve. We started getting denials because we didn’t have their required assessment scores, even though the documentation was clear on the patient’s disease state. This caused approval delays and we had to do our best to make sure the patient did not lapse in their treatment.

It is imperative that we stay as up-to-date as possible with any plan changes, so we can get ahead of the insurance companies.

Communication and Consistency are key

Continuous communication and education to your prescribers and clinical staff is essential to making sure that you are going to receive the documentation you need. Keeping your documentation requests consistent will help prescribers and staff’s consistency and efficiency. The clinical staff is already stretched while being in the clinic with the prescribers, so keeping it as simple as possible will help them and you, and ultimately the patient. Majority of practices work with an Electronic Medical Record (EMR), making it easy to set up protocols to assist with thorough and consistent documentation.

The protocols will vary depending on the diagnosis, but they should ALL include:

tried and failed treatments
clinical assessments
Weight
medication dosing
tests ordered
Quality of life

For those practices still working with paper charts, updated handouts and assessment score sheets will significantly help the staff and prescribers with their documentation.

Everyone’s goal in this field is to maximize patient outcomes. We ask for thorough documentation to ultimately make everyone’s lives easier and the patients’ lives better. Providing us with the documentation needed results in faster turnaround times, increased approval rates, office efficiency, and patient satisfaction.

Lead your prescribers and your team by setting the standard!

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At BC Educators, we are dedicated to empowering biologic coordinators, healthcare professionals, and patient advocates with the education, tools, and resources needed to optimize patient care. From expert-led webinars to hands-on training, we provide comprehensive support to help you navigate the ever-evolving landscape of specialty medications and prior authorizations.