Prior Authorization Tracking Log

Track prior authorization requests, approvals, units authorized, and expiration dates by patient to prevent lapses in covered services.

Patient and Request Basics

• Patient Identifier
  Use your organization’s internal patient ID or another minimum-necessary identifier. Do not enter SSN.
• Patient Initials
  Optional secondary identifier if needed for internal tracking.
• Service Type
• Service Description
  Briefly describe the covered service or treatment plan. Keep details limited to what is needed for authorization tracking.
• Request Date
  Date the prior authorization request was submitted.

Payer and Authorization Details

• Payer Name
• Plan or Policy Number
  Collect only if needed for operational tracking. Avoid entering full member IDs unless necessary.
• Authorization Request ID
  Reference number assigned by the payer or your internal team.
• Authorization Status
• Submission Method

Approval and Coverage Limits

• Approval Date
• Authorization Start Date
• Authorization End Date
  Expiration date for the approved services.
• Units Authorized
  Enter the number of units approved by the payer.
• Visits Authorized
  Use if the payer authorizes visits instead of units.
• Approval Notes

Denial and Follow-Up

• Denial Date
• Denial Reason
• Appeal Needed?
• Follow-Up Owner
  Person responsible for next action.
• Next Follow-Up Date

Submission and Audit Trail

• Current Record Owner
• Last Reviewed Date
• Renewal Reminder Date
  Set a reminder before the authorization expires to prevent lapses in covered services.
• Internal Notes
  Use for operational notes only. Do not include unnecessary PII.