Prior Authorization Workflow in Patientree

Prior authorization in Patientree is centered on Clinical Billing with an AI Prior Authorization panel.

When to use this workflow

• Imaging, procedures, DME, or specialty meds requiring payer approval
• High denial rates from missing clinical justification
• Staff spending hours in payer portals re-entering the same data

Step 1 — Open clinical billing

1. Navigate to /dashboard/clinical-billing.
2. Locate the patient invoice or service line needing authorization.
3. Confirm clinical documentation supports medical necessity.

Step 2 — Draft with AI assistance

Open the Prior Authorization panel to:

• Pull context from clinical notes and orders
• Draft payer-specific justification language
• List required attachments (notes, labs, conservative therapy trial)

Always have clinical staff verify facts before submission — AI drafts are not guarantees of approval.

Step 3 — Submit and track

1. Submit through your payer channel (portal, fax, or clearinghouse — depends on payer).
2. Record authorization number, effective dates, and visit limits in Patientree.
3. Set staff alerts for pending and expiring auths.

Step 4 — Denials and appeals

When denied:

• Capture denial reason code in billing notes.
• Attach supplemental documentation.
• Use structured appeal templates per payer.

Track turnaround time monthly — aim to reduce days-in-auth for high-volume procedures.

Metrics

KPI	Why it matters
Average auth turnaround	Patient access + revenue timing
Denial rate by payer	Contract or documentation issue
Staff hours per auth	ROI of automation

See also: Prior authorization AI solution.

FAQ

Does Patientree submit to payers automatically?
Patientree assists with drafting and tracking; payer connectivity varies by integration. Confirm your clinic’s submission channel.