Clinical justification, peer-to-peer calls and appeals stay with your staff. The software organizes documents and deadlines, and it is fully HIPAA compliant.
Every pending authorization in one place
Each request shows the payer, procedure, visit date, status and owner, sorted by what is closest to becoming a problem. Supervisors see which requests are aging and which visits are at risk this week.
- Payer, plan and procedure
- Visit date and days remaining
- Status from requested to decided
- Every payer contact on record
Payer requirements checked first
Payer-specific checklists compare what is attached with what that payer usually asks for, so missing notes are caught before submission. Your team owns and updates the checklists.
- 1 Order received
- 2 Requirements checked
- 3 Request submitted
- 4 Payer followed up
- 5 Decision recorded
Warnings before a visit is at risk
When a request gets close to its visit date without a decision, the owner is reminded, then a supervisor. Staff can escalate with the payer or move the visit, instead of finding out that morning.
✕One person's spreadsheet
✓A live queue for the whole team
✕Missing notes found after a denial
✓Gaps flagged before submission
✕Visit-day surprises
✓Alerts days before a visit
Payer patterns
Turnaround and denials by payer and procedure show where to push. Where a payer or clearinghouse offers an integration, status updates can flow through it.
The system handles
- Building the request checklist
- Reminding owners before deadlines
- Recording payer status changes
Your people decide
- Clinical justification
- Peer-to-peer calls
- Appeals
