Problem Statement

Authorizations must be resolved before service, and doing it manually is labor-intensive. Staff first have to know which patients need statusing, pulling them from the DAR before querying Carelon. Then they capture the authorization number on approval, 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.

Automation Solution

This automation pulls patients from the DAR, checks authorization status in the Carelon portal, and updates Epic with the current status, including the authorization number if approved.