Patient access and prior authorization operations

The problem

Prior auth packets lived half in the EHR and half on desktops. Payer rules changed quarterly but your checklist was a PDF nobody updated. Patients called for status while agents opened four tabs to see whether a clinical question was even asked yet.

What we built

A HIPAA aware web desk with least privilege roles, encrypted storage for PHI attachments, and an event log you can hand to privacy when someone asks who viewed a record.

• Referral intake captures ordering provider, ICD and CPT hints, urgency, and preferred site so schedulers do not retype the same fields into the EHR export you already run nightly.
• Payer specific prior auth profiles list required labs, imaging, and clinical notes with checkboxes that gate submission until required items are present.
• Unified timeline merges fax images, portal downloads, and manual uploads with timestamps and user identity so denials analysis has a single thread.
• Status codes map to plain language patient scripts your call center can read verbatim when someone asks where the request sits.
• Daily digest emails summarize new denials, peer to peer deadlines, and items sitting in peer review longer than your internal target.

What you gain

Shorter authorization cycle time on high volume service lines, fewer duplicate clinical fetches, and a defensible record when a payer audits whether medical necessity documentation was on file at submit.