Workflow detail

Field calibration

Use this workflow in the room.

Capture what the client confirms, what breaks the hypothesis, and what evidence is needed before a 30-day pilot move.

Ask in the room

Prior authorization packet / response workflow

Use each criterion to test whether the source-backed hypothesis survives this client environment.

Question

Which authorization categories create the most cycle-time drag today?

Client answer / consultant notesEvidence to inspectOwner or stakeholderFollow-up action

Question

Where do staff leave the workflow to assemble clinical or payer-policy evidence?

Client answer / consultant notesEvidence to inspectOwner or stakeholderFollow-up action

Question

Which missing evidence patterns trigger payer requests for more information?

Client answer / consultant notesEvidence to inspectOwner or stakeholderFollow-up action

Question

Who owns clinical review, utilization review, denial response, and appeal escalation?

Client answer / consultant notesEvidence to inspectOwner or stakeholderFollow-up action

Question

How are status updates communicated to clinicians, patients, and scheduling teams?

Client answer / consultant notesEvidence to inspectOwner or stakeholderFollow-up action

Question

What authorization evidence would compliance, audit, or appeal review need later?

Client answer / consultant notesEvidence to inspectOwner or stakeholderFollow-up action

Meeting output

Defer

0/6 confirmed0 blocked

Strongest confirmed signal

No confirmed signal captured yet.

Biggest unresolved risk

Visible pain — Which authorization categories create the most cycle-time drag today?

Suggested 30-day move

Select one authorization category
Inspect recent request and denial files
Map clinical, coding, payer, and status sources
Benchmark cycle time and missing evidence rate

What to send after the meeting

Workflow: Prior authorization packet / response workflow
Recommendation: Defer

Confirmed signals:
- No criteria fully confirmed yet.

Unresolved risks:
- Visible pain: Which authorization categories create the most cycle-time drag today?
- Accessible context: Where do staff leave the workflow to assemble clinical or payer-policy evidence?
- Bounded risk: Which missing evidence patterns trigger payer requests for more information?
- Measurable outcome: Who owns clinical review, utilization review, denial response, and appeal escalation?
- Adoption owner: How are status updates communicated to clinicians, patients, and scheduling teams?
- Reusable pattern potential: What authorization evidence would compliance, audit, or appeal review need later?

Evidence needed:
- Recent prior authorization requests with timestamps
- Clinical notes and order documentation
- Payer policy or medical necessity criteria
- Eligibility and benefits verification
- Payer requests for additional information
- Denials, appeals, and overturn documentation

Follow-up actions:

Suggested 30-day move: Select one authorization category; Inspect recent request and denial files; Map clinical, coding, payer, and status sources; Benchmark cycle time and missing evidence rate; Prototype authorization packet assembly