Check the requirement
Compare the planned service and coverage against payer guidance and practice rules, then flag uncertain requirements for review.
Service 03 / 09
Prior authorizations
FERO supports the administrative life of prior authorization: identifying likely requirements, assembling a complete request, tracking payer response, and keeping clinical decisions with the care team.
Requirement checksRequest trackingDecision follow-up
The challenge
Details matter. So does momentum.
Authorization rules differ by payer, plan, service, and setting. A request can stall because information is missing, a status is not followed, or the approved window no longer matches the service.
Track authorization requirements, submissions, decisions, and expirations before they interrupt care or payment.
Where robot workers fit
A defined job for every step.
Tasks are mapped to the systems and controls in your environment. People review exceptions and remain accountable for decisions.
Prepare the request
Gather administrative details and identify missing clinical documents before a person submits through an approved portal, API, or 278 workflow where available.
Track the decision
Record request identifiers, statuses, approved units or dates, and follow-up deadlines; route adverse or unclear responses to clinical staff.
Operational blueprint
What goes in. What comes back.
A useful worker has known inputs, an exception path, and measures that reveal whether the process is helping.
Inputs to connect
- Order and service details
- Coverage and payer rules
- Required clinical documents
- Authorization response and validity dates
Send to a person
- Medical necessity or clinical evidence question
- Adverse determination or peer review
- Urgent care timing or expiring approval
Measures to watch
- Requests pending by age
- Missing-document rate
- Authorization-related denials
A case in the queue
A service has an authorization on file, but the approved date window ends before the scheduled visit. The worker flags the mismatch for access and clinical staff to resolve.
The human role
Judgment stays with your team.
Clinicians supply and approve clinical evidence, handle medical necessity discussions, and decide how to respond to adverse determinations.
The intended result
More room for the work that counts.
The goal is a more reliable authorization record and fewer preventable claim problems after care.
Start with a conversation
Let's talk about prior authorizations.
Tell us where work gets stuck. We will explore the process, the people involved, and where robot workers can make a useful difference.