Using Prior Auth
Recording submission and outcomes
Prior Auth doesn't talk to payers. You send the PDF through the payer's portal, fax or whatever channel they require, then record what happened here so the request, its timeline and any appeal stay accurate.
Mark submitted
On a request that is Ready to submit, fill in:
- Payer reference number: optional, from the payer's portal or confirmation (up to 80 characters).
- Date submitted: leave blank for today. A date in the future isn't accepted.
Then choose Mark submitted. The request moves to Submitted and shows in the Submitted tab.
Record the decision
When the payer answers, open the request and choose one outcome:
| Outcome | Use it when | You also provide |
|---|---|---|
| Approved | The payer authorized the request. | Decision date (optional), a note such as the authorization number or limits (optional) |
| Partially approved | Some codes or quantities were authorized. | Decision date, and a note saying what was and wasn’t approved. An appeal is built on that note. |
| Denied | The payer declined. | Denial reason (required): choose a category; and What the payer said (required): paste or summarise the stated reason |
Denial categories
Not medically necessary, Missing documentation, Out of network, Not a covered benefit, Frequency or limit reached, Experimental or investigational, or Other.
What happens next
- Approved: nothing more to do. Choose Close request when the service is scheduled.
- Denied or Partially approved: Start appeal, or Close request to accept the outcome. See Appeals.
- Closed and Withdrawn requests are read-only. They stay available for reference.
The timeline
Every move, with who made it and when, appears in the request's Timeline, together with submissions, decisions, exports and appeals. If someone else changed the request while you had it open, you'll be asked to refresh and try again; nothing is half-applied.