End-to-end guide to the prior authorization workflow — from initial request to approval tracking and renewal management.
Authorization requests are triggered automatically when: (1) a new patient's payer requires prior auth, (2) an existing authorization is approaching its visit limit, or (3) a clinician manually requests additional visits. You can also initiate requests from the Auth Center page.
Alex automatically gathers required documentation: the referring physician's order, plan of care, functional limitation reports, outcome measures, and any payer-specific forms. All documents are assembled into a single submission package.
Alex submits through the payer's preferred channel and creates a tracking record in the Auth Center. Each request shows: submission date, payer, patient, requested visits, status (pending/approved/denied), and expected response date.
Approved authorizations are automatically linked to the patient's record with visit limits and date ranges. Denied requests trigger the appeal workflow. Partial approvals (fewer visits than requested) are flagged for review with recommendations.
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