Manage pre-authorizations
How manage pre-authorizations are reshaped as AGI capability advances.
The bottom line
Roughly 90% of the work in Manage pre-authorizations is information-shaped — already within reach of AI delivery. The question here is not whether it shifts, but which tasks go first and who staffs the residual.
Why: With no child occupations seeded, this scalar relies on the APQC process name and description. 'Authorizing claims prior to submittal' under the 'Service products after sales' category represents pure information processing. Because claims verification and pre-authorization consist of document review, administrative rule-checking, and electronic communication rather than physical tasks, the process falls firmly into the digital band.
grounded in the economy graph · digital scalar 0.90 · digital
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How the work flows
Trigger: A provider, employee, or customer submits a request for prior approval of a service, treatment, or expenditure.
- Receive pre-authorization request and supporting documentation
- Verify eligibility and coverage limits
- Evaluate request against policy rules and guidelines
- Request additional information if documentation is incomplete
- Determine authorization decision
- Record decision and generate authorization number
- 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.