Manage pre-authorizations

Trigger: A provider, employee, or customer submits a request for prior approval of a service, treatment, or expenditure.

1. Receive pre-authorization request and supporting documentation
2. Verify eligibility and coverage limits
3. Evaluate request against policy rules and guidelines
4. Request additional information if documentation is incomplete
5. Determine authorization decision
6. Record decision and generate authorization number
7. Notify submitter of the final decision

Outcome: A formal decision to approve, deny, or modify the request is recorded in the system and communicated to the submitter.