Problem Statement

Authorizations must be resolved before service, and doing it manually is labor-intensive. Once an authorization is submitted, the decision sits with the payer. Staff have to check each one to capture the authorization number when approved, 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 the service happens. For payers reachable through Availity, that status is retrieved in the Availity portal.

Automation Solution

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