Draft to decision
Each request moves from draft to submitted to approved or denied, and a denial can be resubmitted. Only valid steps are allowed, and an approval needs the payer’s authorisation number.
Billing / Prior authorisation
Authorisations chased, and approvals caught before they run out.
Requests tracked from draft to decision, the ones nobody chased brought back to the top, and approvals that are about to run out caught before the appointment.
What it does
Prior authorisation, in practice
The ones nobody chased
Submitted requests with no follow-up for seven days are listed first, and “I chased it” records each follow-up.
Approvals about to run out
Approvals ending within 30 days are shown with their end date and the visits approved.
Expired means expired
A nightly job marks approvals past their end date as expired, so an old approval never shows as live.
Visits counted down
Submitting a claim for an approved procedure uses one of the visits approved, and a claim beyond the last one is flagged before it goes.
Who changed what
Every status change is recorded with who made it, and the list filters by status.
How it works
From the first step to the last
- 1
Raise
Patient, payer, procedure, diagnosis and the visits requested.
- 2
Chase
Submitted requests come back to the top when nobody has followed up.
- 3
Track
Approvals are watched to their end date; expired ones stop showing as live.
What it needs
Before you switch it on
Every module switches on and off by itself, per clinic, with its own screens, permissions and audit trail.
Worth knowing
Payers mostly offer no API for this, so requests are still submitted by portal or phone, and the decision is recorded here when it comes back.
See Prior authorisation working on a real system.
The demo runs every module against an unmodified OpenEMR, with invented patients. Nothing to install and no sales call.