Problem Statement

Authorizations must be resolved before service, and doing it manually is labor-intensive. Staff have to check each submitted authorization to capture the approval number, which the claim can't bill without. They also need to catch a denial in time to escalate to the provider and patient, so the care plan can be adjusted before service. Where Availity exposes this through an API, the status can be pulled programmatically instead of by navigating portal screens, removing the manual lookup entirely.

Automation Solution

This automation checks authorization status for patients using Availity APIs and updates Epic with the current status, including the authorization number if approved.