Authorization Request Process Setup for Providers

Help your provider users to easily create and submit authorization requests using FHIR-aligned, industry-specific APIs, along with a predefined suite of Integration procedures and DataRaptors. These components retrieve member information, service requests, and other details required to create an authorization request record and submit the request to the payer.

Available in: Lightning Experience

Available in: Enterprise and Unlimited Editions with Health Cloud

Before you proceed with this process: Set Up Permissions and Data for Utilization Management

OmniStudio Components for the Provider Authorization Request Process
Utilization Management provides a set of predefined OmniStudio Integration Procedures and DataRaptors to retrieve member information from the provider’s Electronic Health Record (EHR) system and to submit the authorization request to the payer’s system.
Built-In MuleSoft Integration to Manage Authorization Requests
Integrate Health Cloud with external Electronic Health Record (EHR) and payer systems by using FHIR Da Vinci Health Record Exchange aligned, industry-specific APIs, and integration applications deployed on MuleSoft. With this Industry Integration Solution, you experience an accelerated and hassle free, end-to-end authorization process.
Set up Integration Definitions for Apex Classes
Use Integration Definitions to quickly set up integrations with different external endpoints using a low code interface. Create integration definitions for Apex classes used to integrate providers with EHR and payer systems. The integration procedures of the provider process call these integration definitions instead of directly pointing to the Apex classes.
Configure Statuses for Authorization Requests from Provider Offices
It’s critical to track the real-time status of each authorization request from submission to approval to make quick, informed decisions on the patient's care. To help your users efficiently use Utilization Management’s highly refined technological workflows, define the required case statuses.
Configure Priorities for Authorization Requests
Authorization requests can have multiple priorities depending on, for example, a patient’s health condition diagnosis or the services requested by the provider. For the end-to-end authorization request process to work effectively, set up the required priorities.
Configure the Partial Request Outcome for Authorization Requests
The outcomes of authorization requests vary depending on factors such as the patient’s member plans or the payer’s clinical review guidelines. To help your authorization coordinators successfully manage the authorization request process, define a request outcome named Partial. The other required outcomes, Queued, Error, and Complete are available by default.
Configure Action Buttons for Submitting and Inquiring about Authorization Requests
Help your provider users to launch OmniScripts and handle authorization request submissions and inquiries in an efficient manner by adding FlexCard-based action buttons to pages.

Health Cloud Administration

Authorization Request Process Setup for Providers