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.
Request outcome is closely tied with case status. Based on the outcome received from the
payer, Health Cloud updates the case status. Ensure you have these exact request outcomes and
case statuses in your org.
| Request Outcome |
Case Status |
| Queued |
Pended |
| Error |
Errored |
| Partial |
Pended |
| Complete |
Approved |
| Complete |
Denied |
|
Available in: Lightning Experience
Available in: Enterprise and Unlimited Editions with Health
Cloud
|
| To add request outcomes: |
Update on care request extensions |
-
From Setup, open the Object Manager, and click Care Request
Extension.
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Select Fields & Relationships, then click Request Outcome.
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Click New in the Request Outcome Picklist Values section.
-
Enter Partial.
Enter the exact value to ensure your users don’t face issues when
processing authorization requests.
-
Save your changes.
Your users can now easily track the outcome of authorization requests.
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