Insurance Authorization Tracking Log

Per-patient log for tracking insurance authorization requests, payer response times, denial reasons, and follow-up actions.

Patient and Request Basics

• Patient Identifier
  Use the internal medical record number or other approved patient identifier. Do not enter SSN.
• Patient Name
  Enter the patient name as used in the authorization request.
• Payer / Insurance Plan
  Name of the insurance company or plan.
• Authorization Type
• Service or Procedure Requested
  Brief description of the requested service, procedure, or medication.
• Request Date
  Date the authorization request was submitted.

Payer Response Tracking

• Submission Method
• Current Response Status
• Payer Response Date
  Date the payer responded, if a response has been received.
• Response Time (Days)
  Number of calendar days between submission and payer response.
• Authorization Number
  Enter the authorization or reference number if provided by the payer.
• Approved Units / Visits
  Number of units, visits, or doses approved, if applicable.

Denial and Follow-Up

• Denial Reason
• Follow-Up Action
• Follow-Up Date
  Date the most recent follow-up action was completed.
• Appeal Status
• Notes
  Add concise notes about payer communication, missing items, or next steps.

Submission and Audit Trail

• Entered By
  Name or username of the staff member entering the record.
• Entry Date
  Date this log entry was created.
• Supporting Documents
  Upload authorization letters, payer correspondence, or appeal documents if needed.