Map service requirements
Specify which referral records, orders and payer details each service needs. Keep the visit or procedure date attached so staff can judge the follow-up priority.
Specialty practices
Keep referrals, authorization work and follow-up tied to the right visit, procedure and responsible team.
Workflows for specialty practices.
Referral and network checks
Keep referring-provider details, service requirements and network questions attached to the request.
Example request
Explore this workflow “My doctor sent a referral. Can you check whether I can be seen at your office?”
Prepared for reviewExample
- Referral
- Referring provider and requested service
- Checks
- Required records and network questions
- Next owner
- Referral team · review visit requirements
Staff confirms the requirements for the service and identifies the remaining records or network questions.
Authorization preparation
Collect the order, payer requirements and supporting documents in a packet for authorized staff to review.
Example request
Explore this workflow “I was told my procedure needs authorization. What information does the office need?”
Prepared for reviewExample
- Service
- Order, procedure details and planned date
- Packet
- Payer requirements and available supporting records
- Next owner
- Authorization team · review gaps and clinical support
Authorized staff checks the documentation and decides the next submission or follow-up step.
Status follow-up
Track reference numbers, unresolved requests and the next follow-up date. Staff handles payer questions and clinical decisions.
Example request
Explore this workflow “My scan is next week. Has the authorization decision come back?”
Prepared for reviewExample
- Reference
- Authorization request and service date
- Status
- Available payer response and outstanding information
- Next owner
- Follow-up owner · next check recorded
Staff verifies the payer’s decision and communicates the appropriate next step to the patient.
Setup and review.
Assign follow-up owners
Decide who checks status, handles additional-information requests and follows up with the patient. Keep the reference number and next check with the request.
Confirm source access
Identify the authorized systems used for records and payer responses. Review what the workflow can retrieve or prepare and which actions require staff approval.
What to measure.
- Missing documentation
- Track requests waiting on an order, referral record or supporting document.
- Age of open requests
- Review how long each request has been open and when it was last checked.
- Follow-up ownership
- Check that each unresolved request has an owner and a scheduled next action.
Questions about specialty practices.
Can different specialties use different requirements?
The setup should reflect the records, visit categories and payer questions relevant to each service. Start with a defined workflow, such as imaging authorization follow-up, and review its exceptions before applying the same process to other specialties.
Does preparing a packet mean authorization is approved?
Preparation gathers the order, requirements and supporting material for review. The payer’s decision remains a separate status. Keep the request reference, latest response and unresolved items together so staff can verify the outcome before updating the patient.
What happens when the payer asks for more information?
Attach the request for additional information to the existing reference and route it to the responsible team. Staff determines which records or clinical explanation are appropriate and handles the next submission step under its approval rules.
Start with authorization follow-up.
Follow one request from its reference number to the next payer check and staff decision.