Build a Full Practice AI System with Claude Projects

What it accomplishes for Medical Assistants

Tools: Claude Pro ($20/month) | Time to build: 2-3 hours | Difficulty: Intermediate-Advanced Prerequisites: Comfortable with Claude Pro Projects — see Level 3 guide: "Build Your Personal MA Knowledge Base with Claude Projects"

What This Builds

Instead of a single knowledge base project, you'll build a coordinated system of 3 Claude Projects — each specialized for a different aspect of your work. Together, they replace scattered binders, multiple browser tabs, and inconsistent team knowledge with a single AI-powered reference and drafting system your whole MA team can use.

The three projects:

1. PA Command Center — Prior auth requirements, denial patterns, successful appeal templates
2. Patient Communication Hub — All approved message templates, phone scripts, and patient education content
3. Practice Reference — ICD-10 quick lookup, office protocols, insurer contact directory

Prerequisites

• Claude Pro subscription ($20/month)
• Completed Level 3 Claude Projects guide — you know how to create a project and add documents
• 2-3 hours for initial build (spread over a week is fine)
• Physician or office manager buy-in for sharing access to the team

The Concept

Imagine having three specialized colleagues you can ask questions at any time. One knows everything about insurance requirements. One has memorized all your approved patient communication templates. One is a walking ICD-10 code book with your office protocols memorized. That's what this system builds — three AI "assistants," each deep in their own domain, that the whole team can access.

Build It Step by Step

Part 1: PA Command Center

Create a new Claude Project called: "PA Command Center — [Practice Name]"

Project instructions:

You are a prior authorization specialist assistant for a medical assistant team at a [primary care / specialty] practice. You help with:
1. Looking up prior authorization requirements for specific procedures and insurers
2. Analyzing denial letters to identify the strongest appeal arguments
3. Drafting appeal letters using medical necessity language
4. Running 4-step appeal prompt chains (analyze → strategy → draft → refine)

When answering PA requirement questions: cite the specific requirement from our uploaded documents. If the information isn't in our documents, say so and suggest where to look.

When drafting appeal letters: always use formal medical letter format, medical necessity language, and include [PHYSICIAN NAME], [NPI], [PATIENT NAME], [CLAIM NUMBER] placeholders. One page maximum.

Documents to add (build these in Google Docs first, then paste into Claude):

Document 1: Prior Auth Requirements by Payer Build a text document with:

PRIOR AUTH REQUIREMENTS — [Your Practice] (Updated [Date])

UNITEDHEALTHCARE:
- Cardiology referrals: Required for stress tests (CPT 93015), echos (CPT 93306), cardiac cath
- Spine imaging: MRI lumbar/cervical (CPT 72148, 72141) require PA after 8 weeks conservative tx
- PT/OT: PA after 12 visits for most plans
- Submission: Online at myuhcprovider.com | Fax: [number] | Phone: [number]

AETNA:
[fill in your Aetna requirements]

BCBS:
[fill in your BCBS requirements]

Document 2: Denial Pattern Library Start empty and add entries as you win appeals:

SUCCESSFUL APPEAL LIBRARY (De-identified)

Case 1: UHC / Lumbar MRI / Denial: "Conservative treatment not documented"
Winning argument: PT completion notes + failed NSAID trial + functional limitation documentation
Key language used: "Failure to improve despite completion of standard conservative treatment as defined by UHC clinical criteria..."

Case 2: [add as you go]

Document 3: PA Process Quick Reference

HOW TO SUBMIT A PA AT OUR PRACTICE:

Step 1: Check if the procedure requires PA for this patient's insurer (ask in this chat)
Step 2: Pull required clinical documentation from EHR (last 3 visit notes, relevant labs, imaging results)
Step 3: Submit via insurer portal or fax — use portal when available (faster tracking)
Step 4: Note submission date, reference number, and expected turnaround in our tracking sheet
Step 5: Follow up on day 5 if no decision received
Step 6: If denied, start appeal immediately — most payers have 30-60 day appeal windows

TURNAROUND TIMES (typical, not guaranteed):
- Routine: 3-5 business days
- Urgent: 24-72 hours (mark "urgent" on submission and call to confirm receipt)
- Emergency: Same day (call payer directly, do not fax)

Part 2: Patient Communication Hub

Create a second Claude Project called: "Patient Communication Hub — [Practice Name]"

Project instructions:

You are a patient communication assistant for medical assistants at a [specialty] practice. You help with:
1. Drafting portal message responses (professional, empathetic, under 100 words)
2. Generating appointment reminder content for specific appointment types
3. Writing patient education handouts in plain language (6th-grade reading level)
4. Scripting difficult phone calls

RULES:
- Never include real patient names or PHI — use [PATIENT NAME] placeholders
- Patient-facing language should be warm and clear
- Clinical communications should be professional and precise
- Always note if physician review is needed before sending

Use the approved templates in our documents as the base for responses when available.

Documents to add:

• Your team's approved portal message templates (from the Level 3 guide)
• Your approved phone triage scripts (from the Level 3 guide)
• Common patient education handouts (pull from your Google Docs library)

Part 3: Practice Reference

Create a third Claude Project called: "Practice Reference — [Practice Name]"

Project instructions:

You are a quick-reference assistant for medical assistants at a [specialty] physician office. You help with:
1. ICD-10 code lookup for common diagnoses
2. Office protocols (what to do in specific situations)
3. Insurer contact directory (phone, fax, portal info)
4. Drug reference quick questions (common medications, side effects to communicate to patients)

When answering: be concise and direct. For ICD-10 codes, always list the code + description, note any specificity options, and flag if physician selection is needed. For protocols, provide step-by-step guidance.

Documents to add:

• Your top 50 ICD-10 codes for your specialty
• Insurer contact directory (phone, fax, portal URLs)
• Office emergency protocols
• Common medication education bullet points

Part 4: Test the Full System

Test each project with real questions:

PA Command Center:

• "What does UnitedHealthcare require for an MRI of the lumbar spine?"
• "I have a denial for physical therapy from Aetna. Run me through the appeal chain."

Patient Communication Hub:

• "Draft a portal response for a patient who says they never received their referral and they're frustrated."
• "Script a call for telling a patient their prior auth was denied."

Practice Reference:

• "What's the ICD-10 for uncontrolled type 2 diabetes with CKD stage 3?"
• "A patient is having a hypoglycemic episode in the waiting room. What's the protocol?"

Real Example: Complete PA Workflow in One Session

Scenario: You start Monday morning with 5 pending prior auth denials on your desk.

1. Open PA Command Center (claude.ai → Projects → PA Command Center)

2. For the first denial: "UHC denied an MRI of the lumbar spine for a patient with low back pain. Denial says 'conservative treatment not documented sufficiently.' I have PT notes showing 8 sessions completed with documented failure to improve. Run me through the appeal."

3. Claude runs the 4-step chain using your uploaded payer requirements and appeal templates — producing a draft letter in 10 minutes.

4. For the second denial: "Aetna denied a cardiology referral. Denial says routine. Patient has palpitations and borderline EKG. Similar to Case 2 in my appeal library — can you use that as a template?"

5. Claude finds your de-identified Case 2 example and uses its winning language structure — even faster.

Result: 5 denials processed in 60 minutes instead of 3-4 hours.

What to Do When It Breaks

• "Claude doesn't find the information in my documents" → Try rephrasing: instead of "UHC requirements," try "UnitedHealthcare prior authorization." Make sure your document uses consistent terminology.

• "The project is getting too big and responses are slow" → Split into more specific sub-projects. The system works best with focused, well-organized documents rather than one massive upload.

• "A team member can't access my projects" → Claude Projects aren't directly shareable to other Claude accounts currently. Share the approach with your colleague and have them build their own — or share the underlying Google Doc source materials.

• "Payer requirements in my documents are outdated" → Add a "LAST UPDATED" date to every document section. Set a calendar reminder to review insurer requirements at the start of each year (when plans reset).

Variations

• Simpler version: Just build the PA Command Center first. Add the other two projects over the following weeks as you gather materials.

• Extended version: Add a fourth project — "Scheduling and Admin" — with your EHR scheduling protocols, callback priority matrix, and physician-specific scheduling preferences.

What to Do Next

• This week: Build PA Command Center (highest ROI, most immediate time savings)
• This month: Add Patient Communication Hub and Practice Reference
• Advanced: Schedule monthly 15-minute "document maintenance" sessions — update denial library, refresh payer requirements, add new successful templates

Advanced guide for medical assistant professionals. Patient and practice information loaded into Claude Projects is processed by Anthropic. Review your practice's data governance policies before uploading. For HIPAA-sensitive content, use de-identified examples only.