If you manage an outpatient clinic, you already feel the weight of prior authorization. National surveys from the American Medical Association show that most physicians report care delays linked to authorization requirements, and many have seen patients abandon recommended treatment when paperwork drags on.
The LMN sits at the center of that process. When it is clear and complete, three things tend to happen more often.
From an operations standpoint, a strong LMN is one of the few levers you directly control in a system that often feels outside your influence. It is also one place where technology can quietly help. A unified inbox and AI intake automation, the focus of Solum Health, can centralize messages, surface missing information before you send a request, and shorten the back and forth with payers.
Although payers vary, the basic life cycle of an LMN is remarkably consistent across outpatient specialties.
The process begins with a clinical assessment. The provider documents diagnoses, functional limitations, safety concerns, and goals for care. That assessment is not just a clinical requirement, it is the factual foundation that will support the LMN.
Next, the provider or a delegated clinician writes the letter, usually on practice letterhead. A solid LMN typically includes:
You can think of this as the place where clinical reasoning is translated into plain language for a reviewer who has never met the patient. If that reviewer cannot follow the logic in a quick skim, your team will probably see a request for more information.
The LMN is then attached to a prior authorization request or similar packet. Submission might happen through a payer portal, fax, or clearinghouse. In many clinics, this is where fragmentation shows up, one staff member handles the LMN, another pulls chart notes, someone else watches a separate fax inbox.
A unified communication hub, such as the one described in the solutions overview, can reduce that fragmentation by pairing the LMN with intake data, benefits checks, and supporting records before the request is sent.
At the payer, a clinical reviewer evaluates the LMN against coverage policies. They are looking for alignment between the diagnosis, the requested service, and the defined medical necessity criteria. Specific, concrete language tends to travel further than general phrases about quality of life.
The payer issues a decision. If approved, the LMN effectively becomes part of the record of why care is being delivered. If denied, the LMN often anchors any appeal. In either case, a clear document reduces confusion when staff need to explain the decision to the patient.
If you want to improve LMNs without overwhelming your team, you can tackle it as a focused workflow project rather than an abstract documentation goal.
Several patterns show up repeatedly in clinics that struggle with LMNs.
As you refine this work, you can look at your own metrics or at published success stories in automation to see how LMN quality relates to denial trends and staff workload.
What should be included in a Letter of Medical Necessity?
A strong LMN includes the patient’s identifiers, diagnoses, functional limitations, the specific service or equipment requested, clear clinical reasoning for that choice, expected outcomes, proposed frequency and duration, and the provider’s credentials and signature.
Who can write a Letter of Medical Necessity?
Any licensed healthcare professional involved in the patient’s care can typically write an LMN, for example physicians, nurse practitioners, physician assistants, and licensed therapy providers, subject to payer rules.
Is an LMN always required for prior authorization?
Not every authorization needs an LMN, but many payers require one for non routine, high cost, or longer term services. When in doubt, sending a succinct LMN with the initial request usually reduces follow up.
How long is a Letter of Medical Necessity valid?
Validity is set by the payer. Some recognize an LMN for the entire period of an authorization, others ask for updated letters after a certain number of visits or months, or when the treatment plan changes.
Can patients request a copy of their LMN?
Yes, patients have the right to access documentation related to their care, including LMNs, as part of their medical record. Make sure your release of information process covers this scenario.
If you want more context around intake, communication, and revenue topics that intersect with LMNs, the blog and broader resource library can help, along with related entries in the glossary.
To make this practical, you can treat LMN improvement as a short, contained project.
Across that timeline, keep the big picture clear. Solum Health positions its platform as a unified inbox plus AI intake automation for outpatient facilities, specialty ready, integrated with EHR and practice management systems, and built to show measurable time savings. LMNs are only one slice of your pre visit work, but they sit at a crucial junction. If you tighten this process, and pair it with tools that tackle intake and communication at scale, you make it easier for patients to access care and for your staff to keep the clinic moving.
