> ## Documentation Index
> Fetch the complete documentation index at: https://help.clinikehr.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Request a pre-authorization

> Ask an insurer to approve treatment before you deliver it, with the codes, quantities and costs the payer needs to decide.

export const StillStuck = ({topic}) => <div className="ck-callout ck-callout--note" role="note">
    <p className="ck-callout__body">
      <strong>Still stuck{topic ? ` with ${topic}` : ''}?</strong>{' '}
      Check <a href="/platform/help/troubleshooting">Troubleshooting</a> first —
      it covers the failures we see most often. If that does not resolve it,{' '}
      <a href="/platform/help/contact-support">contact support</a> and include
      your workspace name and the time the problem happened, so we can find the
      matching entry in your audit log.
    </p>
  </div>;

export const TaskHeader = ({before, time, after}) => <div className="ck-task">
    {before ? <div className="ck-task__cell">
        <div className="ck-task__title">Before you start</div>
        <p className="ck-task__body">{before}</p>
      </div> : null}

    {time ? <div className="ck-task__cell">
        <div className="ck-task__title">Takes about</div>
        <p className="ck-task__body">{time}</p>
      </div> : null}

    {after ? <div className="ck-task__cell">
        <div className="ck-task__title">When you're done</div>
        <p className="ck-task__body">{after}</p>
      </div> : null}
  </div>;

export const Path = ({steps = []}) => <span className="ck-path">
    {steps.map((s, i) => <span key={i} className="ck-path__step">
        {i > 0 ? <span className="ck-path__sep" aria-hidden="true">
            ›
          </span> : null}
        {s}
      </span>)}
  </span>;

export const Availability = ({editions = ['all'], plans, roles, note}) => {
  const list = editions.includes('all') ? ['clinic', 'pharmacy', 'lims'] : editions;
  return <div className="ck-avail" role="note" aria-label="Feature availability">
      <span className="ck-avail__label">Available in</span>

      {list.map(e => <span key={e} className={`ck-pill ck-pill--${e}`}>
          {EDITION_LABELS[e] || e}
        </span>)}

      {plans ? <span className="ck-avail__label">Plan</span> : null}
      {plans ? <span className="ck-pill ck-pill--plan">{plans}</span> : null}

      {roles ? <span className="ck-avail__label">Who</span> : null}
      {roles ? <span className="ck-pill ck-pill--role">{roles}</span> : null}

      {note ? <span className="ck-avail__note">{note}</span> : null}
    </div>;
};

<Availability editions={['clinic']} plans="Enterprise" roles="Owners, managers, accountants and billers" note="Needs the Insurance care area switched on." />

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.

<Path steps={['Sidebar', 'Insurance', 'Pre-Authorization']} />

<TaskHeader before="The insurer added under Companies, its prices set, and the patient's policy on file" time="5 minutes" after="A submitted request you can track to approval or denial" />

## 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:

| Tab           | What it holds                                            |
| ------------- | -------------------------------------------------------- |
| **Overview**  | Summary tiles for volume, pending work and approval rate |
| **Requests**  | The searchable list of every request                     |
| **Analytics** | Status mix and how it is moving                          |
| **Activity**  | Who did what to a request, and when                      |

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.

## Raise the request

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

<Steps>
  <Step title="Open a new request">
    Select **New Request**. The form opens on **Basic Info**, headed **Patient & Request Information**.
  </Step>

  <Step title="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.
  </Step>

  <Step title="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.
  </Step>

  <Step title="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.
  </Step>

  <Step title="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.
  </Step>

  <Step title="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.
  </Step>

  <Step title="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.
  </Step>
</Steps>

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.

## 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](/hospital/insurance/claims) afterwards.

## Who can do this

**Role** decides whether the screen opens. On Enterprise, an owner controls which roles reach **Insurance** 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.

**Permission** decides what a person may do inside. The **Billing** section of your staff sheet carries the ones that matter here:

| Action                      | Who can do it by default           | Permission                   |
| --------------------------- | ---------------------------------- | ---------------------------- |
| Raise and submit a request  | Owner, manager, biller             | **File insurance claims**    |
| Pull what a payer covers    | Owner, manager, accountant, biller | **Request coverage reports** |
| Record a payer's settlement | Owner, manager, biller             | **Add insurance payments**   |
| Change a negotiated price   | Owner, manager, biller             | **Edit service fees**        |

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.

## 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.

## Common issues

<AccordionGroup>
  <Accordion title="The patient's insurer is not in the picker">
    Add the insurer on the **Companies** tab of the [Insurance dashboard](/hospital/insurance/overview) first, then reopen the request.
  </Accordion>

  <Accordion title="No requests found, but we raised several">
    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**.
  </Accordion>

  <Accordion title="I cannot find the right code">
    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.
  </Accordion>

  <Accordion title="The unit cost is not what we agreed with this payer">
    Payer-specific prices live under **Insurance** → **Pricing**. Fix the negotiated price there so every future request is right.
  </Accordion>

  <Accordion title="The request was denied">
    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.
  </Accordion>

  <Accordion title="Pre-Authorization is not in my sidebar">
    Either the **Insurance** [care area](/hospital/get-started/care-areas) is off, or the hospital is not on Enterprise. See [Change your plan](/platform/plans/change-plan).
  </Accordion>
</AccordionGroup>

## FAQ

<AccordionGroup>
  <Accordion title="Do I need a pre-authorization for every patient?">
    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.
  </Accordion>

  <Accordion title="Is anything sent to the insurer automatically?">
    No. The request is prepared and tracked here, and you send it to the payer the way you already do.
  </Accordion>

  <Accordion title="Can I add an item after submitting?">
    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.
  </Accordion>

  <Accordion title="Does an approval guarantee payment?">
    It removes the commonest reason for refusal, not every one. The claim still has to match the approval on items, quantities and dates.
  </Accordion>

  <Accordion title="What does the AI Analysis column do?">
    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.
  </Accordion>
</AccordionGroup>

<StillStuck topic="a pre-authorization" />