Prior Authorizations
Create and manage prior authorization requests
Prior authorizations (PAs) are requests submitted to insurance providers to obtain approval before a medical service is performed. Each PA tracks the full lifecycle from creation through approval or denial, including documents, notes, and step therapy history.
Viewing prior authorizations
Navigate to Prior Authorizations from the main menu to see all prior authorizations in a paginated list.
Table columns
ID
Unique identifier (e.g., PA-123)
Patient
Patient name
Status
Current authorization status
Request Date
When the PA was created
Expiration Date
When the authorization expires
Service Date
Expected date of service
Payer
Insurance provider name
Location
Service location
Filtering
Use the filter bar to narrow results by:
Status — Pending, Submitted, Approved, Denied, Cancelled, Expired, or Peer to Peer
Request Date — date range
Service Date — date range
Sorting
Sort by created date, service date, expiration date, next touch date, or patient name — in ascending or descending order.
Search
Use the search bar to find prior authorizations across all text fields.
Creating a prior authorization
Click the Create button to open the creation form.
Select a PA type:
Prescription
Medications and pharmaceuticals
Procedure
Surgeries and medical procedures
Imaging
CT scans, MRIs, PET scans
Fill in the required fields:
Patient
Yes
Select a patient (must have an insurance plan on file)
Insurance Plan
Yes
Select one of the patient's insurance plans
Physician
Yes
Select a healthcare provider
Location
Yes
Select a service location
CPT Codes or Diagnosis Codes
Yes
At least one CPT code or diagnosis code is required
Service Date
No
Expected date of service
Click Create to submit the prior authorization.
Enable the Create More toggle to keep the form open after saving, allowing you to quickly create multiple prior authorizations in a row.
Creating from a treatment
When linking a PA to a treatment, the physician, location, service date, CPT codes, and diagnosis codes are automatically inherited from the treatment and cannot be edited on the PA form.
Step therapies (Prescription type only)
For prescription-type PAs, you can document previous medications tried before requesting authorization:
Click Add Step Therapy.
Fill in the therapy details:
Medication Name
Yes
Name of the medication from the drug catalog
Medication Dosage
No
Dosage and strength
Start Date
Yes
When the patient started this medication
End Date
No
When the patient stopped
Failure Reason
No
Why this medication was insufficient
Add multiple therapies and drag to reorder them.
AI verification
When a prior authorization is created, the system automatically runs AI-powered verification in the background before submission. This process validates the PA against payer-specific rules and requirements without any manual action needed.
The AI verification checks:
Payer rules — whether the procedure or medication is covered by the payer and that all payer-specific requirements and documentation guidelines are met
Data completeness — that all required fields and supporting information are present on the PA
Submission method — determines the appropriate way to submit to the payer (portal, fax, or phone) based on payer preferences
Once verification completes, results are added as a system-generated note on the PA. If the PA passes validation, it proceeds toward submission. If issues are found, the PA is flagged for manual review.
Prior authorization statuses
Pending
Initial status when a PA is first created
Submitted
Request has been sent to the payer
Approved
Payer has approved the authorization
Denied
Payer has denied the request
Peer to Peer
Requires a peer-to-peer review with the payer
Cancelled
The request has been cancelled
Expired
The authorization has expired
Once a PA reaches Approved, Denied, Cancelled, or Expired status, it can no longer be edited.
Prior authorization details
Click on any prior authorization in the list to open its detail page.
Overview
PA ID (e.g., PA-123)
Status (editable via dropdown)
Authorization number (editable — enter the number provided by the payer)
Request date
Expiration date (editable)
Next touch date (editable — for follow-up tracking)
Treatment information
Service date, physician, and location
CPT codes and diagnosis codes
If linked to a treatment, fields are marked as inherited
Step therapies
View, add, edit, or remove previous medication therapies
Drag to reorder therapies
Right-side panel
Patient — patient demographics
Insurance — plan type, group number, policy number, effective and expiration dates
Documents — upload and manage supporting documents
Notes — add notes and comments to the PA
Updating status
From the detail page, use the status dropdown to update the PA status as it progresses through the authorization workflow. Each status change is tracked for audit purposes.
Managing documents
Upload supporting documents (e.g., medical records, letters of medical necessity) from the Documents section on the detail page. Documents can be uploaded via drag-and-drop or file selection.
Adding notes
Open the Notes section on the detail page to add notes or comments related to the prior authorization.
Linking to treatments
Prior authorizations can be linked to treatments. When linked:
The PA status is synced to the treatment's workflow steps
The PA appears in the treatment's linked records section
Treatment fields (physician, location, service date, codes) are inherited by the PA
You can link a PA to a treatment when creating the PA, or from the treatment detail page.
How prior authorizations connect to other features
Treatments
PAs are a workflow step in the treatment lifecycle. Linking a PA to a treatment syncs status updates to the workflow.
PA Determination
A Required determination indicates that a PA should be submitted for the procedure.
Eligibility Checks
Eligibility results may indicate whether prior authorization is needed for covered services.
Payer Network
The payer's contact methods and portal information are used when submitting prior authorizations.
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