Problem Statement

Authorization and referral denials from Aetna, Allways, and BMC (reason codes CO197 and CO243) require staff to research each account in the payer portal and determine whether an authorization exists, a manual triage step that delays resolution and, left unworked, turns recoverable denials into write-offs.

Automation Solution

This automation reviews these authorization denials in the payer portals and updates Epic to label each account as auth found, not found, or mismatched, routing accounts for the right follow-up and reducing manual review.