Skip to main content
A pre-authorization asks an insurer to agree, in advance, that they will pay for something. Get it before you treat and a claim is a formality; skip it and a claim for a procedure that needed approval is a denial waiting to happen. Pre-Authorization needs the Insurance care area in Settings → Facility. See Care areas.

​
Raise the request

1

Open a new request

From Pre-Authorization, start a new request. The form opens on Patient & Request Information.
2

Identify the patient and the request

Choose the Patient — the picker says “Select patient…” — then the Request Type and a Priority Level. The first two are required. Priority is what tells your own team which requests cannot wait, so set it honestly.
3

Set the deadlines

Submission Deadline is when you must have sent it; Authorization Deadline is when you need an answer by. Both drive your follow-up, so fill them in even when the payer has not stated one.
4

Add the items

Add a line for each thing you want approved. Each line takes an Item Type, the item itself, a Description, a Quantity and a Unit Cost — all required. Tariff Code, Tariff ID and Diagnosis carry the payer’s own reference where you have one.
5

Attach the codes

Under ICD 10/CPT CODE, search with “Search ICD-10, CPT, or HCPCS codes…” and attach the codes that justify the request. This is the field payers read first: a request with a procedure code and no diagnosis code supporting it is the most common avoidable denial.
6

Review and submit

Add anything else under Additional Notes, then use Review & Submit. Read the summary before you send — you are asking a payer to commit money against what is on that screen.
Prices on the request come from the payer-specific rates you set under Insurance → Pricing, not from your standard service list. If a figure looks wrong, the negotiated price is where to fix it.

​
Track the answer

The Pre-Authorization Requests list is where you chase. Search across “Search requests, patients, insurance…”, or filter by status and by type. The stats above it show Total Requests, Pending, Approved and your Approval Rate — a falling approval rate is usually a coding problem, not bad luck. When an insurer responds, record their decision on the request. An approval is what you quote on the claim later.

​
Check it worked

  • The request appears in Pre-Authorization Requests with a status, the patient and the insurer.
  • The Pending count on the stats row has gone up by one.
  • Every item you expect to deliver is on the request — an item that is not on it is not approved, even if the rest of the request is.

​
If something goes wrong

Add the insurer on the Companies tab of the Insurance Dashboard first, then record the patient’s cover on Coverage.
“Search ICD-10, CPT, or HCPCS codes…” matches on name, code and description, so try the clinical term rather than the number. If nothing fits, describe it precisely under Description — a payer will query a vague description, and a query costs more time than the search did.
Payer-specific prices live under Insurance → Pricing. Fix the negotiated price there so every future request is right, rather than overtyping it on each one.
Read the payer’s reason against the codes you submitted. Most denials at this stage are a missing supporting diagnosis, a quantity beyond what the plan allows, or an item the patient’s cover excludes. Correct it and raise a new request rather than arguing the old one.
Either the Insurance care area is off, or the workspace is not on the Enterprise plan. An owner can turn the care area on in Settings → Facility; see Change your plan for the plan.