Pre-Authorization Workbench

Manage, track, and document pre-authorization requests to payers

Auth ID	Auth Number	Patient	Payer	Procedure	Diagnosis	Requested	Approved	Status	Submitted	Validity	Aging

New Pre-Authorization Request

Patient *

Encounter

Payer *

Policy / Member ID

Diagnosis ICD-10 *

Diagnosis Description

Requested Procedure / Service *

CPT Code

Requested Amount (QAR)

Expected Date of Service

Clinical Justification *

Notes

Authorization Detail