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            Create and Submit Authorization Requests for Review

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            Create and Submit Authorization Requests for Review

            As an intake coordinator, you often create and review care requests for need assessment. With information coming in from various sources—member plan details, provider information, care request details, and more—there’s increased chances of administrative errors.

            Required Editions

            Available in: Lightning Experience

            Available in: Enterprise and Unlimited Editions with Health Cloud

            The Authorization Intake process helps you save time and cut down on errors. You can create an authorization request of type Inpatient, Outpatient, or Concurrent review. Depending on the request type, the request creation process varies.

            New Request (Inpatient or Outpatient) Concurrent Review for an Existing Request
            1. Create requests from the Utilization Management for Payers app
            2. Check member eligibility and assess the need of service requested
            3. Add information related to the request, including diagnosis and service codes
            4. Update provider details
            5. Add supporting documents
            6. Review request
            1. Create concurrent reviews from the Utilization Management for Payers app or the Case record page of the linked request
            2. Link to an existing request if you started the concurrent review from the app’s home page
            3. Add information related to the request, including diagnosis codes and update service code details
            4. Add supporting documents
            5. Review request
            1. Select an Authorization Request Type
              Select either inpatient or outpatient for a new request, or concurrent review for an existing request.
            2. Run an Eligibility Check for Your Care Request
              Verify members’ benefits coverage and check which care request services require an authorization.
            3. Link a Concurrent Review to an Existing Request
              Ensure members continue to get timely and cost-effective care by performing concurrent reviews for an existing request during the course of a member’s treatment.
            4. Add Care Request Details to the Authorization Request
              Authorizations require that you add details about the requested service. The details you enter depend on whether the care request is new or existing, and inpatient or outpatient.
            5. Add Provider Details to the Authorization Request
              Enter information about the requesting provider, servicing provider, and the servicing facility where the service will occur. You can automatically see if the provider is inside or outside the payer network.
            6. Upload Supporting Documents for the Authorization Request
              Authorization requests often require supporting clinical documents. In the Authorization Intake process, the Upload Clinical Documents window provides a checklist of required documents.
            7. Review the Authorization Request
              Before submitting an authorization request, you see an overview where you can override the document status and add notes or observations.
             
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