Authorization Request Process Setup for Providers

Before you proceed with this setup, complete Set Up Permissions and Data for Utilization Management

• Authorization Request Process Flow in a Provider’s Office
  Utilization Management’s solution for providers gathers necessary clinical information from the Electronic Health Record (EHR) system and establishes a connection with the clearing house or payer system. With this seamless integration, provider users can efficiently create and submit authorization requests and deliver timely care to patients.
• Omnistudio Components for the Provider Authorization Request Process
  Utilization Management provides a set of predefined Omnistudio Integration Procedures and Omnistudio Data Mappers to retrieve member information from the provider’s Electronic Health Record (EHR) system and to submit the authorization request to the payer’s system.
• Built-In MuleSoft Integration to Manage Authorization Requests
  Integrate Health Cloud with external Electronic Health Record (EHR) and payer systems by using FHIR Da Vinci Health Record Exchange aligned, industry-specific APIs, and integration applications deployed on MuleSoft. With this Industry Integration Solution, you experience an accelerated end-to-end authorization process.
• Set up Integration Definitions for Apex Classes
  Use Integration Definitions to quickly set up integrations with different external endpoints using a low code interface. Create integration definitions for Apex classes used to integrate providers with EHR and payer systems. The integration procedures of the provider process call these integration definitions instead of directly pointing to the Apex classes.
• Define Provider Statuses for Authorization Requests
  Track the real-time status of each authorization request from submission to approval to make timely, informed decisions on the patient's care. To help your users efficiently use Utilization Management’s workflows, define the required case statuses.
• Configure Priorities for Authorization Requests
  Authorization requests can have multiple priorities depending on, for example, a patient’s health condition diagnosis or the services requested by the provider. For the end-to-end authorization request process to work effectively, set up the required priorities.
• Configure the Partial Request Outcome for Authorization Requests
  The outcomes of authorization requests vary depending on factors such as the patient’s member plans or the payer’s clinical review guidelines. To help your authorization coordinators successfully manage the authorization request process, define a request outcome named Partial. The other required outcomes, Queued, Error, and Complete, are available by default.
• Configure Action Buttons for Submitting and Inquiring about Authorization Requests
  Help your provider users to launch Omniscripts and handle authorization request submissions and inquiries in an efficient manner by adding Flexcard-based action buttons to pages.