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Reviewing a Request

The Overview screen is a single workspace: patient and provider on the left, coding in the center, notes on the right, and all actions in the sticky top bar.

AreaContents
Top barAuthorization number · linked order · status pill · Update status menu · Report · Script / Rx
Left railPatient (with MRN) · Requesting provider · Reviewer & guideline (dates, visits, review result)
CenterDiagnosis codes (A–L) · Procedure codes & place of service · Appointments · Clinical findings
Right railNotes (add, edit, delete your own)

The Authorization Overview screen

1. Review the request document​

Click Report in the top bar to open the request document — this is the provider's authorization request. Review it alongside:

  • Script / Rx (top bar) — the prescription / order document, when attached.
  • Clinical findings (center) — findings extracted from each medical record, with View / Download / Chat per record.
  • Reviewer & guideline (left rail) — prior review dates, visit counts, and the last review result.

2. Fill in the diagnosis codes​

Diagnosis codes dialog with lettered, reorderable codes and ICD-10 search

  1. On the Diagnosis codes card, click Edit.
  2. Search by ICD-10 code or description (e.g. S83.211A or sprain). Click a result to add it; click again to remove it.
  3. Codes are lettered A–L in the order you add them — up to 12. Use the ↑ / ↓ buttons to change which letter a code holds.
  4. Click Save.
The letters are the diagnosis pointers

Procedure lines reference diagnoses by letter (A–L) — the same pointers that appear on the CMS-1500 / 837P claim. Order the codes so the primary diagnosis is A.

3. Fill in the procedure codes and place of service​

Procedure codes dialog with place of service, CPT search, modifiers, and diagnosis pointers

  1. On the Procedure codes card, click Edit.
  2. Set the header fields:
    • Place of Service — e.g. 11 — Office, 24 — Ambulatory surgical center.
    • Service Location — the address where care is delivered.
  3. For each procedure line:
    • Procedure (CPT) — search by code or name and pick from the list. Every line must have a procedure before you can save.
    • Mod 1–4 — modifiers as applicable (e.g. LT, 59).
    • Units — number of units.
    • Rendering NPI — the rendering provider's NPI.
    • Medicare provider / facility rate — reference rates for pricing.
    • Diagnosis pointers — toggle the A–L letters this line treats.
    • Status — per-line Approved / Rejected once you have made a determination.
  4. + Add procedure line for additional lines; Remove deletes a line.
  5. Click Save.

4. Leave a note​

Use the Notes rail to record anything the next reviewer or the intake team needs — records requested, callbacks, guideline citations. Notes take 2–1000 characters; you can edit or delete your own notes.

5. Update the status​

Finish by moving the request to the right status from the Update status menu in the top bar — see Statuses for what each one means and which ones collect extra information.