1. Patient Insurance Verification
✔ Confirm patient’s active insurance coverage
✔ Identify if prior authorization is required for services
✔ Record payer-specific authorization rules and codes
2. Authorization Request Submission
✔ Submit requests through payer portals or fax
✔ Include diagnosis, procedure codes, and clinical notes
✔ Track submission dates for follow-up
3. Approval Monitoring
✔ Log all pending authorizations with status updates
✔ Communicate outcomes with providers and patients
✔ Resubmit or escalate denials immediately
4. Documentation and Billing Integration
✔ Store approval letters or reference numbers in the patient’s file
✔ Link authorization IDs with the claim at time of billing
✔ Ensure services match what was approved
5. Common Challenges & Fixes
| Challenge | Fix |
| Missing or delayed authorization | Use task reminders and daily authorization checks |
| Denied claims due to auth errors | Cross-verify codes and approval scope before billing |
| Payer rule confusion | Maintain a digital reference sheet by insurance |
| Lack of communication between teams | Centralize updates using a shared authorization log |
