Administer pre-authorizations

Trigger: A medical provider, repair facility, or policyholder submits a formal request and supporting documentation for approval of proposed services or treatments.

1. Receive pre-authorization request and supporting evidence
2. Verify policyholder coverage and applicable limits
3. Review proposed service for medical or technical necessity
4. Escalate complex requests to specialized adjusters or medical directors
5. Make final approval or denial determination
6. Notify requester of the decision and any conditions
7. Update the claim file with authorized parameters

Outcome: A formal approval, modification, or denial is communicated to the requesting party and documented with authorized limits in the claim system.