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A pre-authorization asks an insurer to agree, in advance, that they will pay for something. The codes you attach here are what the insurer approves against — get them right and the claim that follows is a formality, get them wrong and you are appealing a denial you could have prevented.

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What you’re looking at

The heading reads Pre-Authorization Management — “Manage insurance pre-authorization requests with AI-powered analysis”. A date-range picker, Refresh, Export and New Request sit beside it. Four tabs: The Requests list carries Request #, Patient, Type, Status, AI Analysis, Cost, Created At and Actions. Request #, Patient, Type, Cost and Created At all sort. Above it sit a search box — “Search requests, patients, insurance…” — and All Statuses and All Types filters, which list only the values your own requests actually use. Empty state. A hospital with nothing raised, or a filter that matches nothing, shows No requests found. Clear the search and set both filters back to All before concluding a request is missing.

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Raise the request

The form is a set of tabs you work through in order. Each one answers a question the payer will ask.
1

Open a new request

Select New Request. The form opens on Basic Info, headed Patient & Request Information.
2

Identify the patient and the request

Choose the Patient and a Request Type — both required — then a Priority Level. 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. Additional Notes carries anything else the reviewer should read.
4

Add the items

On Items & Services, add a line for each thing you want approved. Item Type, the item itself, Quantity and Description are required; Unit Cost, Tariff Code, Tariff ID, Diagnosis and Medical Necessity carry the payer’s own references and your justification.
5

Attach the codes

Still on each item, use ICD 10/CPT CODE and search with “Search ICD-10, CPT, or HCPCS codes…”. This is the field payers read first: a procedure code with no diagnosis code supporting it is the commonest avoidable denial. The search matches name, code and description, so try the clinical term rather than the number.
6

Confirm the cover

On Insurance Details, choose the Insurance Company and Insurance Plan. If the patient has nothing on file, select Add Insurance and complete the Add Insurance Details dialog — it is saved against the patient for next time.
7

Review and submit

On Review & Submit, read the summary back. You are asking a payer to commit money against exactly what is on that screen, so an item missing here is an item that is not approved.
Costs on the request come from the payer-specific rates under Insurance → Pricing, not from your standard fees. If a figure looks wrong, the negotiated price is where to fix it.

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Track the answer

Work the Requests tab by status. The AI Analysis column shows whether an automated review has run — a prompt to look again before you send, never a decision. The Overview tiles are your chase list: a rising pending count means requests are sitting, and a falling approval rate is almost always a coding problem rather than bad luck. When the insurer answers, record their decision on the request — an approval is what you quote on the claim afterwards.

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Who can do this

Role Navigation is what decides who gets here. The page itself checks nothing — its old hardcoded role list was retired — so anyone who can reach the Insurance group can raise, submit and read a pre-authorisation. Under Settings → Role Navigation accountants and billers reach it by default, alongside owners and managers, and a role with no rule of its own is unrestricted. Your staff sheet’s Billing section does carry File insurance claims, Add insurance payments, Request coverage reports, Edit service fees and View financial dashboard, and they are recorded against each person — but no insurance screen reads them, so they change nothing today. Restrict insurance at the Role Navigation layer instead. Enforcement is opt-in per person: a colleague never saved in the permissions sheet is unrestricted, and the sheet warns “Saving starts enforcing” before that changes. A denied action is recorded; an allowed one is not. Hiding Insurance from a role is a convenience, not a security boundary.

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Check it worked

  • The request appears on Requests with a Request #, the patient and a status.
  • The Cost column matches what you expect the payer to approve.
  • Every item you intend to deliver is on the request — one that is not on it is not approved, however the rest is answered.

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Common issues

Add the insurer on the Companies tab of the Insurance dashboard first, then reopen the request.
Clear the search box and set All Statuses and All Types, then check the date-range picker at the top of the page and select Refresh.
Search on the clinical term rather than the number. If nothing fits, describe it precisely under Description and Medical Necessity — 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.
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 cover excludes. Correct it and raise a new request rather than arguing the old one.
Either the Insurance care area is off, or the hospital is not on Enterprise. See Change your plan.

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FAQ

No — only where the plan says so. Switch on Pre-authorization Required on that plan under Insurance → Plans so your team can see which ones demand it.
No. The request is prepared and tracked here, and you send it to the payer the way you already do.
Raise a fresh request for it. An approval covers the items that were on the request when the payer read it, so amending after the fact is not a change the payer has seen.
It removes the commonest reason for refusal, not every one. The claim still has to match the approval on items, quantities and dates.
It flags gaps in a request before a human sends it — a prompt to look again, never a decision. Submitting is always a person’s act.