Step 1
Order in
Procedure or medication order from the EHR
← Healthcare playbook · Use case
Prior authorization packets
Powered by QAO PriorAuth Pack
“Prior authorizations stall for days on missing documentation.”
Who feels it: Revenue cycle director, prior authorization coordinators
The problem today
Staff check each payer's rules, search the chart for supporting notes and results, and fill payer forms by hand. Missing documents send requests back, care is delayed, and some services go ahead without approval and are later denied.
Our approach
QAO PriorAuth Pack reads the order and the clinical record, checks the payer's requirements, assembles the packet and flags anything missing before submission. Coordinators review and submit; nothing goes to a payer without a person's approval.
How it works
From order to payer decision.
Step 2
Payer rules agent
Checks requirements and gathers evidence
Step 3
Coordinator review
Fixes gaps and approves the packet
Step 4
Payer submission
Sent electronically and tracked to decision
Data and systems
EHR orders and notesLab and imaging resultsPayer policiesInsurance eligibilityFHIR APIs
Value at stake
What changes.
75%
Reduction in packet assembly time
40%
Reduction in requests returned for missing documents
100%
Requests tracked to a payer decision
Solution families
Capabilities used