priorauth.indocs

Authorization lifecycle

The whole flow, from a surgery appearing on a schedule to the authorization number landing on the appointment. Every point where software stops is marked.

#End to end

diagram
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The two filled boxes are the only places software will not continue on its own.

#The two stops

There are exactly two places where software will not continue on its own: transmitting to a payer, and changing a clinical record. Both are consequential in a way that cannot be undone by a retry, and both carry a named human in the audit record afterwards.

#Where it can end early

OutcomeWhenWhat happens
stoppedThe payer does not accept 278 on this networkEnds before assembling anything. Prior-auth support varies by payer more than any other transaction.
invalidThe draft fails payer validationStops before the wire, not after a rejection.
abstainedNothing authoritative answers whether auth is neededRaises a task naming what could not be determined.
refusedSource systems disagree about the patientFails closed. See Veradigm.
routed_to_humanAn adverse determinationNever written back, never communicated by software.
deadFollow-up exhausted its attemptsBecomes a human task. Nothing is silently abandoned.