Prior authorization

Authorization performance comes from explicit states, named owners, ready evidence, and stage-level timing, whichever channel carries the request.

Structured intake removes avoidable rework by making payer, service, evidence, and deadline requirements visible before anything is submitted.

Submission due dates, payer response windows, approved-service windows, and appeal deadlines are four different timers with four different consequences.

A denial should carry the request, the decision rationale, the evidence, the deadline, and the appeal outcome, all in one place.

Prior authorization is a payer review that may be required before a medication or service is covered.

Clear communication and a documented follow-up plan reduce confusion while a coverage decision is still pending.

An appeal is a formal request to reconsider a coverage decision, using the process and the supporting information the plan specifies.

Start the day with a focused view of open authorization work, deadlines, and decision outcomes.

Start an authorization case with the request details and supporting information a payer review needs.

Manage open authorization requests by status, urgency, and next action.

Bring request details, payer communication, supporting information, and next actions together for one case.

Confirm the request is complete and ready for the payer route before it goes out.

Track authorization denials that are being reconsidered or appealed.

Keep an authorization appeal organized from denial review through to the payer outcome.

Identify approvals that need scheduling, renewal, or patient communication before they lapse.

Give authorization staff one place to read the payer-specific guidance your organization maintains.