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HEALTH-INSURANCE-OPERATIONS4 MIN READ

Sort prior-auth next actions

Sort prior-authorization cases into next-action buckets based on completeness, urgency, and review readiness.

Sort each prior-auth case by the next action that should move it. Clinical review ready Provider outreach needed Eligibility correction needed Member or provider status needed Request has service code, diagnosis, policy-required notes, and active coverage Request has order and diagnosis but missing the conservative-therapy note named in policy Member shows active on employer file but inactive in core admin for the requested date Determination is complete, but the provider office has called twice and has not received status Urgent imaging request includes all clinicals and the plan rule is loaded Specialty medication auth is missing the latest lab value…

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