Track Prior Authorizations

A prior authorizations process should make the source, owner, and next action visible before a patient is affected. A record for requests, payer status, dates, and denials.

Track Prior Authorizations: quick overview

Start by naming the event that creates the record. A record should enter because a defined condition occurred, not because someone remembered to add a task. Record the patient, the source, the owner, and the evidence expected at intake.

The main risk is that an authorization can expire or be denied without follow-up. A written rule keeps routine coordination separate from clinical judgment.

Capture the evidence

A usable record includes patient, payer, service, request date, status, expiry, and owner. Keep the source beside the record so another reviewer can reconstruct what happened.

The billing lead confirms the decision or exception. The assistant can check status, record dates, and route clinical questions, but should not fill a gap with an assumption.

Separate preparation from judgment

Decisions about clinical necessity and coverage decisions remain with the authorized clinical or billing owner. Use three labels: proceed under the rule, pause for missing evidence, and escalate for a decision.

Review the HIPAA assistant guide and medical fax workflow for related controls.

Run the review

Review pending authorizations, expirations, and denials. For example, an authorization expires before a procedure. Record what evidence was available and who owned the next step.

Pilot one workflow

Start with one payer. Test the checklist on a small batch and review exceptions with the owner.

Use the practice operations service as a starting point for scope and evidence.