Prior authorization is one of the most common sources of avoidable denials and treatment delays. The problem is rarely effort. It is usually the absence of a written process that tells each person what to do, when, and how to record it.
A four-step workflow
- Identify: when a visit or order is scheduled, check whether the planned services require authorization
- Submit: send the request with the clinical notes the payer requires, and record the date and reference number
- Track: follow up on pending requests at a fixed interval, such as every two business days
- Confirm: record the approval, its validity dates, and the approved units or visits
Common failure points
Authorizations are often approved for a date range or a number of visits. Patients who exceed the approved count, or who are seen after the approval expires, generate denials that look like administrative errors. Build an alert for both the end date and the visit count.
Assign one owner for each category of authorization. When everyone is responsible, pending requests stall because nobody feels accountable for following up.
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