Good morning, Doctor.

Your AI-powered prior authorization command center.

PA Success Rate

87%

↑ 12% from last month

Avg. Approval Time

3.2 days

↓ 1.4 days improved

Active PAs

24

8 need attention

Pending Appeals

6

3 urgent

Quick Actions

Most common workflows

AI Capabilities

Powered by Claude AI

PA

Auto-generate PA letters

Complete, insurer-specific letters in seconds

Predict

Predict approval criteria

Anticipate what each insurer needs before denial

Appeal

Intelligent denial appeals

Targeted appeals citing guidelines & case law

P2P

Peer-to-peer call scripts

Exact words to say, objection handling ready

Rheumatology Drug Coverage Landscape

Common PA requirements by drug class

Drug Class	Key Examples	Typical Step Therapy	PA Complexity
TNF Inhibitors	Humira, Enbrel, Remicade, Cimzia, Simponi	2+ csDMARDs (MTX required for RA)	Moderate
JAK Inhibitors	Xeljanz, Olumiant, Rinvoq	MTX + 1 TNFi (most payers)	High
IL-6 Inhibitors	Actemra, Kevzara	MTX ± TNFi failure	Moderate
IL-17 Inhibitors	Cosentyx, Taltz, Bimzelx	NSAIDs ± csDMARDs (AS/PsA)	Moderate
B-Cell Agents	Rituxan, Benlysta, Saphnelo	MTX + 2 TNFi (rituximab RA)	High

PA Submission Tool

AI-powered prior authorization preparation and letter generation

1

Select Drug

2

Patient & Insurance

3

Clinical Data

4

Generate Letter

Search & Select Drug

Choose the medication requiring prior authorization

Patient Information

Patient Initials / ID *

Date of Birth

Primary Diagnosis *

Disease Activity

DAS28 / CDAI / Activity Score

Insurance Information

Insurance Company *

Member ID

Group Number

PA Reference # (if renewal)

Request Type

Clinical Documentation

The stronger the clinical data, the better the PA outcome

Prior Treatment History *

Include: drug name, dose, duration, outcome, reason for stopping — the more specific the better

Clinical Summary & Disease Activity

RF / Anti-CCP Status (RA)

Radiographic Changes

Functional Status (HAQ / mHAQ)

TB Test Result

Hepatitis Screening

Prescribing Physician

NPI Number

AI Letter Generation

Generate a comprehensive, insurer-specific PA letter

Insurance Requirements Database

PA requirements, contact info, and step therapy policies by insurer

Step Therapy Requirements Matrix

By drug class and major insurers

Drug / Class	UHC	BCBS	Aetna	Cigna	Medicare
TNF Inhibitors Humira, Enbrel, etc.	2 csDMARDs + biosimilar	2 csDMARDs	CPB 0174 criteria	2 csDMARDs	Medical necessity
JAK Inhibitors Xeljanz, Rinvoq, Olumiant	MTX + 1 TNFi required	MTX + 1 TNFi	MTX + 1 TNFi	MTX + 1 TNFi	Plan dependent (Part D)
IL-6 Inhibitors Actemra, Kevzara	MTX + 1 TNFi (RA)	MTX ± TNFi	CPB 0473 criteria	MTX + TNFi	Medical necessity
IL-17 Inhibitors Cosentyx, Taltz	NSAIDs/csDMARDs (PsA/AS)	NSAIDs + csDMARDs	NSAIDs + csDMARDs	NSAIDs + csDMARDs	Medical necessity
Rituximab (RA) Rituxan + biosimilars	MTX + 2 TNFi + Hep B	MTX + 1-2 biologics	MTX + 2 TNFi	MTX + 1 TNFi	LCD criteria + Hep B

Denial Appeal Generator

AI-powered denial analysis and appeal letter generation

Denial Details

Drug Denied *

Insurance Company *

Diagnosis

Primary Denial Reason *

Denial Letter Text / Details

Clinical Information

Prior Treatment History

Appeal Process Timeline

1

Receive Denial

Note date — appeal deadlines start here (typically 30-180 days)

2

Request P2P (within 14-30 days)

Peer-to-peer is often fastest path — try before formal appeal

3

Submit Level 1 Internal Appeal

Formal written appeal with clinical evidence

4

External Independent Review (IRO)

Request external review if internal appeal denied

5

State Insurance Commissioner

Escalate to state regulator for commercial plan denials

Peer-to-Peer Preparation

AI-generated call scripts, objection handling, and winning arguments

Case Setup

Tell us what you're dealing with

Your Name / Credentials

Drug Being Requested *

Insurance Company

Patient Diagnosis *

Reason for Denial

Clinical Summary

Before the Call — Checklist

Patient chart open PA denial letter in hand PA reference number ready Prior treatment dates & doses documented Disease activity scores calculated (DAS28, CDAI, BASDAI) Labs from past 6 months available Pen and paper to take notes Know the reviewer name if possible

Your P2P Script Will Appear Here

Fill in the case details on the left and click Generate to get your personalized peer-to-peer call script with opening lines, arguments, objection handling, and closing strategy.

Settings

Configure your RheumAuth instance

Anthropic API Key

Required for all AI features

API Key

Your API key is stored only in your browser's local storage. It is never sent anywhere except directly to Anthropic's API.

Get API Key →

Practice Information

Used in generated letters

Practice Name

Physician Name

NPI Number

Practice Phone

Practice Address

About RheumAuth

RheumAuth is a clinical decision support tool for rheumatology practices. It helps prepare prior authorization requests, appeal denials, and prepare for peer-to-peer reviews using AI.

Disclaimer: RheumAuth is a support tool. All generated content should be reviewed by a licensed physician before submission. Insurance requirements change frequently — always verify with the payer directly.

PA Tracker

Track every prior authorization — status, deadlines, and renewal alerts all in one place.

Approved

0

Pending

0

Denied

0

Expiring Soon (30 days)

0

Patient	Drug	Insurance	Submitted	Expiration	Status	PA #	Actions
📋 No PAs tracked yet Click "Add New PA" above to start tracking your first prior authorization

💡 Tip: PAs expiring within 30 days are highlighted in orange. Renew early — most insurers need 2–3 weeks for renewal processing. Data is saved in your browser and persists between sessions.