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            Define Payer Statuses for Authorization Requests

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            Define Payer Statuses for Authorization Requests

            Care requests move through a series of steps from submission to approval. To get a clear understanding of the progress and assignment of requests, it’s critical to track the real-time status.

            Required Editions

            At a high-level, a typical authorization care request transitions through each of these stages:

            • Intake Specialist or Coordinator creates authorization requests based on the details shared by the provider or member.
            • Admin Reviewer performs the first level of review.
            • Utilization Management Nurse performs a clinical review of the request.
            • Medical Director reviews and provides the final determination of the requests they receive.

            To help your users efficiently use Utilization Management’s workflows, define appropriate case statuses. To make things easy for you, case substatuses are already predefined.

            Available in: Lightning Experience

            Available in: Enterprise and Unlimited Editions with Health Cloud
            User Permissions Needed
            To add case status: Update on Case object
            1. From Setup, open the Object Manager, and go to the Case object.
            2. Under Fields & Relationships, click Status.
            3. Click New in the Status Picklist Values section.
            4. Enter these authorization request status values: Intake, Admin Review, Nurse Review, MD Review, and Determination. Enter each value on its own line.
              Important
              Important Enter these exact values to ensure the right authorization-related Omniscripts launch for your users.
            5. Save your changes.
              Now, your users can easily track the progress of authorization requests.

            You can now select the case status picklist values that appear in the Path component of the Case page to help your user view the various stages of a care request process.

            See Also

             
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