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Run: Insurance Authorization Tracking Log

Track each insurance authorization request from submission to payer response in one per-patient log. Use it to monitor turnaround time, denial reasons, follo...

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Patient and Request Basics

Patient Identifier (required)

Use the internal medical record number or other approved patient identifier. Do not enter SSN.

Patient Name (required)

Enter the patient name as used in the authorization request.

Payer / Insurance Plan (required)

Name of the insurance company or plan.

Authorization Type (required)

Service or Procedure Requested (required)

Brief description of the requested service, procedure, or medication.

Request Date (required)

Date the authorization request was submitted.

Payer Response Tracking

Submission Method (required)

Current Response Status (required)

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 (required)

Name or username of the staff member entering the record.

Entry Date (required)

Date this log entry was created.

Supporting Documents

Upload authorization letters, payer correspondence, or appeal documents if needed.

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