Prior Authorization Templates

You can pre-create prior authorization templates so that every request for a given procedure collects the same supporting documentation. Creating a template is usually the first step in setting up prior authorizations: build one per procedure (or per group of procedures) that captures what the payer asks for, so your team isn't assembling the clinical justification from scratch on each request.

A template does not need to include the insurance, procedure codes, associated diagnoses, ordering provider, service facility, or units requested. Those fields are captured on every prior authorization request regardless of which template is used, so the template only covers the documentation that is specific to the procedure.

Here are the following types of questions that you can ask in a prior authorization template:

• Multiple Choice
• Dropdown
• Short Answer
• Grid
• Number
• Paragraph
• Date
• Time
• Picture
• File
• Statement
• Consent
• SSN
• Address
• Allergy
• Medication
• Condition
• Vitals
• PDF Upload
• Editor

You can find the definitions of each of the question types here.

Steps

Step 1: Create a prior authorization template (EMR)

To create a prior authorization template:

• Go to the EMR (e.g. emr.avonhealth.com)

• Click on the hamburger menu on the top left corner > Settings > Prior Authorization Templates

• Click "Create a template"

• The "Add Template" modal will pop up. In it, set:

  • Name: Name of the prior authorization template. Naming it after the procedure it covers makes it easier to pick the right one when creating a request.
  • Description: Description of the prior authorization template

• Click "Add section" to add a section to the template

• Click "Add question" to add a question to the template

• Select the type of question you want to ask.

• For each question, set:

  • Required: Whether a response to this question is required
  • Title: Title of the question where it says "type your title here"
  • All other parameters are specific per question type

• Click on any template details, section, or question card to edit it. Press the Delete button with the red outline to delete an entire section of the template and the trash can icon to delete a question in the template.

• Drag a section or question card when it's in view mode to reorder it.

Step 2: Embed in logic (EMR)

You can embed logic into the sections and questions in the prior authorization template. Follow the instructions here to embed logic.

Step 3: Publish the template (EMR)

Press "Publish" to publish all of the changes and make the template available to organization members.