Prior Authorization Preparation
Assemble the administrative and supporting clinical information an authorization request needs. Give the reviewer a clear view of what is present, what is missing and which service the packet supports.
How the work moves.
Authorization work moves more smoothly when the required information is in one place.
- 01
Check the service and payer requirements.
Match the patient, ordered service and payer requirements before assembling the request.
- 02
Identify missing clinical or administrative documents.
List required documents and identify gaps without inventing clinical findings or rationale.
- 03
Prepare the request for authorized staff review.
Organize the available material for the authorized reviewer to check before submission.
A request,
with its context intact.
An imaging order needs authorization. The order and service details are available, but the payer’s requested supporting visit note has not been attached.
Fictional example · No patient data or external action
- Prepared
- Patient, payer, order and service context
- Outstanding
- Supporting visit note
- Next action
- Request the missing record, then review the packet
Start with the
right information.
Keep these details with the request so the next person can review the work without repeating the intake.
- Patient, payer and member information
- Ordering and servicing provider details
- Planned service, date and available codes
- Order, supporting records and payer requirements
About this workflow.
Does preparing a packet submit an authorization?
Preparation, review and submission are separate steps. Submission depends on the practice’s authorized channel and approval process.
Who decides clinical necessity?
The authorized clinical team supplies and approves the clinical rationale. Fluent organizes the available information and keeps missing evidence visible.
Related workflows.
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