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MODULE 19: INTERPROFESSIONAL COLLABORATION
Section 4: Standardized Communication Templates
A practical guide to building an arsenal of pre-formatted emails and EHR messages for common scenarios, such as PA status updates, requests for additional information, and denial notifications, ensuring clarity and consistency.
SECTION 19.4
Standardized Communication Templates
Building Your Communication Playbook for Efficiency and Clarity.
19.4.1 The “Why”: From Repetitive Task to Strategic System
In any given week as a CPAP, you will encounter the same handful of scenarios dozens, if not hundreds, of times: a request for chart notes, a notification of a step-therapy requirement, an update on an approved PA. If you approach each of these interactions as a unique event, writing every message from scratch, you are engaging in a massive, unnecessary expenditure of your most valuable resources: time and mental energy. You are also introducing the risk of inconsistency, where one provider’s office receives a clear and comprehensive update, while another gets a hurried, incomplete note. This creates unpredictable workflows and undermines your professionalism.
The solution is to stop viewing these communications as individual tasks and start viewing them as components of a highly efficient, strategic system. This is the purpose of developing a robust library of standardized communication templates. A template is not a lazy shortcut; it is a powerful tool for quality control. It is a pre-built, peer-reviewed, and optimized communication that encapsulates the best possible way to convey a specific piece of information. It ensures that every communication you send is complete, professional, and contains the precise data points the recipient needs to take the appropriate next action.
By building and deploying a template library, you achieve three critical objectives. First, you dramatically increase your efficiency, freeing up valuable time to focus on complex clinical problem-solving rather than repetitive typing. Second, you ensure consistency across all your communications, which builds trust and predictability with your collaborating teams. They learn that a message from you will always contain the information they need in a format they recognize. Third, you elevate your professionalism. A well-crafted template is a sign of a well-organized professional who respects the time of others. This section provides a comprehensive, practical guide to building your own arsenal of communication templates, transforming your daily messages from a chore into a strategic asset.
Retail Pharmacist Analogy: The “SIG” Library
Imagine typing prescription labels without the use of standardized SIG (directions for use) codes. For every amoxicillin prescription, you would have to manually type out “Take one capsule by mouth three times daily for ten days.” For every lisinopril, “Take one tablet by mouth once daily.” Not only would this be incredibly time-consuming, but the risk of error would skyrocket. You might type “twice daily” by mistake, or forget to include the duration of therapy.
This is why every pharmacy dispensing system has a robust library of pre-programmed SIG codes. When you type “1T PO TID x10D,” the system instantly and perfectly translates this into the full, patient-friendly instructions. This system is the epitome of efficiency, safety, and consistency. The SIGs have been carefully crafted and vetted to be as clear as possible.
Your communication templates are your professional SIG library. Instead of a “1T PO TID” for a drug, you will have a “[PA_REQUEST_MORE_INFO_METFORMIN_TRIAL]” for a common clinical scenario. Just as the SIG ensures every patient gets clear, correct instructions on their vial, your templates ensure every nurse, prescriber, and care manager gets clear, correct information in their inbox. It’s not about avoiding thinking; it’s about systematizing the routine so you can devote your brainpower to the truly complex challenges.
19.4.2 Principles of Effective Template Design
A powerful template is more than just pre-written text; it’s a carefully designed communication tool. Before we dive into specific examples, it’s crucial to understand the foundational principles that make a template effective. Each template you build, regardless of the scenario, should be filtered through these five principles.
Masterclass Table: The Five Pillars of Template Design
| Principle | Core Question | Key Characteristics | Example in Practice |
|---|---|---|---|
| Clarity | Is the purpose of this message instantly recognizable? |
|
Subject: “Action Required: PA for John Smith – Missing A1c” instead of “PA Update”. |
| Conciseness | Is this the shortest possible message that still conveys all necessary information? |
|
“Payer requires trial of metformin” instead of “I was looking at the insurance company’s website and it appears that their policy states that a trial of metformin is one of the requirements for this medication to be approved.” |
| Completeness | Does the recipient have everything they need to take the next step without having to ask a follow-up question? |
|
Providing the formulary alternatives in the denial notification, so the provider doesn’t have to look them up. |
| Professional Tone | Does this message represent you and your organization in a professional and collaborative manner? |
|
“Could you please provide the chart notes from the last visit?” instead of “I need the chart notes now.” |
| Action-Oriented | Is it perfectly clear what action you want the recipient to take? |
|
“Please respond to this message with the date of the metformin trial to proceed.” instead of “Let me know about the metformin.” |
19.4.3 The Template Arsenal: A CPAP’s Core Library
Now, let’s build your arsenal. The following are detailed, ready-to-use templates for the most common scenarios you’ll face. These should be stored in a retrievable format (e.g., a Word document, EHR smart phrases, or a text expansion application) for easy access. Note the use of placeholders like [Patient Name], which you will replace with the specific case details.
A Note on “Smart Phrases” and Automation
Many Electronic Health Record (EHR) systems (like Epic or Cerner) have a built-in “smart phrase” or “dot phrase” functionality. This allows you to save a template and insert it into a message by typing a short code (e.g., “.pa_moreinfo”). If your system has this capability, it is the most efficient way to manage your template library. Work with your IT or informatics department to get your templates built into the system. This is a massive workflow enhancement.
Category 1: Intake and Initial Requests
These templates are used at the very beginning of the PA process to gather the necessary information to build your case.
Template 1.1: Request for Initial Clinical Documentation
Use Case: When you have a new PA request but have not been provided with any of the patient’s medical records.
Subject: Request for Clinicals – PA for [Drug Name] – [Patient Name], DOB: [Patient DOB]
Dear [Provider Office Contact Name or “Clinical Team”],
We have received a prior authorization request for the above patient and medication. To proceed with the submission to [Payer Name], we require the following clinical documentation:
- Most recent office visit note detailing the treatment plan and rationale for [Drug Name].
- Relevant lab results (e.g., A1c, eGFR, LFTs).
- Documentation of any past medication trials for this condition, including dates and reasons for discontinuation.
Please fax the records to [Your Fax Number] or attach them in a reply to this message. Our PA case reference number is [Case #].
Thank you for your prompt assistance.
Sincerely,
[Your Name/Department Name]
[Your Contact Information]
Template 1.2: Notification of Missing/Illegible Information
Use Case: When the initial information from Intake or the provider’s office is incomplete or unreadable.
Subject: ACTION NEEDED: Incomplete Information for [Patient Name] PA – Case #[Case #]
Hello [Provider Office Contact Name],
We are working on the prior authorization for [Drug Name] for [Patient Name]. The process is currently on hold as some of the initial information is incomplete.
Specifically, we need:
[CHOOSE ONE OR MORE]
- A valid primary diagnosis (ICD-10) code for this prescription.
- A legible copy of the front and back of the patient’s pharmacy insurance card. The copy we received was unreadable.
- The specific quantity and day supply for the prescription (e.g., #30 tablets for 30 days).
To resolve this, please [Provide a specific action, e.g., ‘reply to this message with the diagnosis code’].
We cannot proceed with the submission until this information is received.
Thank you,
[Your Name/Department Name]
[Your Contact Information]
19.4.4 The Template Arsenal: In-Process Updates
These templates are your workhorses for keeping the care team informed while the PA is under review. Proactive updates are a hallmark of an exceptional CPAP.
Template 2.1: Confirmation of PA Submission
Use Case: To be sent immediately after you have successfully submitted the case to the payer. This closes the loop and sets expectations.
Subject: FYI: PA Submitted for [Patient Name] – [Drug Name] – Case #[Case #]
Hello Team,
This is a notification that the prior authorization request for [Drug Name] for [Patient Name] was successfully submitted to [Payer Name] today, [Date], at [Time].
The payer’s standard review time is [e.g., 24-72 hours, 3-5 business days]. No further action is needed from your end at this time.
We will provide another update as soon as the determination is received.
Thank you,
[Your Name/Department Name]
Template 2.2: Payer Request for Additional Information
Use Case: When the payer reviews the case and pends it, asking for a specific piece of clinical information that you do not have.
Subject: URGENT Action Required: PA for [Patient Name] – Payer Needs More Information
Hello [Provider Office Contact Name],
[Payer Name] has reviewed the PA for [Drug Name] for [Patient Name] (Case #[Case #]) and has requested additional information before making a final decision.
Specifically, they are requesting: [Be very specific, e.g., ‘Documentation of the patient’s trial of metformin, including start/end dates and reason for failure.’ or ‘The patient’s most recent LFT lab results.’]
The PA is on hold and the review clock is stopped until we can provide this to them.
Please provide the requested information by [Fax/EHR Message Reply] at your earliest convenience so we can avoid further delays.
Thank you,
[Your Name/Department Name]
[Your Contact Information]
19.4.5 The Template Arsenal: Communicating Determinations
These are the most important templates. The way you communicate an approval or a denial sets the stage for everything that happens next. Clarity here is paramount.
Template 3.1: PA Approved Notification
Use Case: The best news you get to deliver. This template ensures all key details of the approval are communicated to the team.
Subject: GOOD NEWS: PA Approved for [Patient Name] – [Drug Name]
Hello Team,
Great news! The prior authorization for [Drug Name] for [Patient Name] has been APPROVED by [Payer Name].
Approval Details:
- Effective Date: [Start Date]
- Expiration Date: [End Date] (Authorization is valid for [Length, e.g., 12 months])
- Authorization #: [PA Number]
- Next Steps: [e.g., ‘The prescription has been sent to [Pharmacy Name].’, ‘Patient may now schedule their infusion.’, ‘No further action is needed.’]
A copy of the approval letter has been saved to the patient’s chart. Please let me know if you have any questions.
Best regards,
[Your Name/Department Name]
Template 3.2: PA Denied – Notification & Plan of Action
Use Case: The most critical template in your library. It must deliver the bad news clearly but immediately pivot to a proactive plan, preventing despair and guiding the team toward a solution.
Subject: PA DENIED for [Patient Name] – [Drug Name] – PLAN OF ACTION
Hello Dr. [Provider Name],
The prior authorization request for [Drug Name] for [Patient Name] was DENIED by [Payer Name].
Reason for Denial: [Quote the exact reason from the letter, e.g., “Patient has not completed a trial of a preferred formulary alternative.”]
PLAN OF ACTION / NEXT STEPS:
We have two primary options:
1. Appeal the Decision: If you believe this medication is medically necessary and the patient cannot use the preferred agents, we can initiate a formal appeal. This process can take up to 30 days.
2. Switch to a Formulary Alternative: The payer’s preferred formulary alternatives are [List 1-2 specific drug names]. Switching to one of these agents would be the fastest path to getting the patient on therapy.
Please advise how you would like to proceed. If you would like to switch, please let me know which agent you prefer and I can assist with the new prescription. If you wish to appeal, please let me know and I will begin preparing the case file for our appeals team.
The denial letter is attached for your full review.
Sincerely,
[Your Name/Department Name]
[Your Contact Information]
