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Run: Prior Authorization Tracking Log

Track prior authorization requests, approvals, authorized units, and expiration dates in one log so patient services do not lapse between payer decisions and...

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Patient and Request Basics

Patient Identifier (required)

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 (required)

Service Description

Briefly describe the covered service or treatment plan. Keep details limited to what is needed for authorization tracking.

Request Date (required)

Date the prior authorization request was submitted.

Payer and Authorization Details

Payer Name (required)

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 (required)

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.

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