Insurance & Authorization Tracker

The Insurance & Authorization Tracker provides a unified view of coverage verification and prior authorization workflows across encounters. It consolidates payer responses, submission timelines, and task ownership into a single dashboard, ensuring that authorizations are complete and valid before service or admission.

By linking scheduled procedures and admitting orders to payer policy rules, the tracker reduces last-minute cancellations and billing denials. It flags visits at risk of authorization delays, routes reminders to assigned staff, and maintains auditable artifacts for compliance and post-event review.

Benefits

• Reduces day-of cancellations: Surfaces missing or pending authorizations before admission or procedure start.
• Improves clean-claim rate: Ensures authorization data aligns with payer rules and claim requirements.
• Enhances accountability: Assigns clear ownership and escalation paths for each authorization task.
• Strengthens audit readiness: Stores payer responses and documentation as traceable artifacts linked to encounters.

Capabilities

• Centralized authorization dashboard: Displays coverage and auth status by patient, encounter, and scheduled service.
• Worklist by visit/service: Organizes pending items with filters for payer, location, or timeframe.
• Reminders and escalations: Sends notifications for expiring or delayed authorizations to prevent service disruption.
• Artifact storage: Maintains attachments (payer responses, forms, correspondence) as FHIR DocumentReference resources for auditability.
• Eligibility and coverage checks: Integrates with X12 270/271 or FHIR CoverageEligibilityRequest APIs for real-time validation.
• Integration hooks: Aligns with EMR scheduling, case management, and revenue cycle systems to maintain workflow continuity.

Great for

• Patient Access and Authorization Teams: Monitor coverage and prior authorization progress across visits to reduce cancellations and expedite service readiness.
• Revenue Cycle and Billing Analysts: Improve clean-claim rates by linking services to payer policy rules and tracking submission-to-response timelines.
• Compliance and Audit Leads: Maintain defensible documentation and visibility into authorization workflows through structured artifact storage and audit logging.
• Operational Leadership: Track authorization turnaround performance and identify systemic delays by payer, service line, or department.