Claims

Captures the total dollar amount billed by a provider for services covered under a prior authorization. Used in claims adjudication to compare submitted charges against the authorized allowed amount and identify billing discrepancies, overpayments, or services rendered beyond approved scope.

The member or patient date of birth recorded on a prior authorization request for identity verification and eligibility validation purposes. Stored in utilization management and payer systems to confirm member demographic accuracy, prevent authorization fraud, and ensure services are approved for the correct enrolled beneficiary.

The arterial pressure value for a service pre-approval. Used in healthcare data management and clinical workflows. This field is commonly used in electronic health records (EHR), healthcare information systems (HIS), and clinical data warehouses for authorization management and reporting.

Records the date on which an active prior authorization was voided or withdrawn before services were rendered or completed. Used in utilization management systems to close authorization records, prevent claim payment against cancelled approvals, and support reporting on authorization attrition.

Categorization label for authorization within Billing processes in Healthcare implementations. Used for reporting, integrations, and downstream analytics.

Standardized code identifying the type or category of prior authorization request submitted to a health plan. Authorization category codes classify requests by service type such as inpatient admission, outpatient procedure, specialty referral, or durable medical equipment. Used in utilization management systems and claims adjudication to validate that services received match authorized service categories.

Captures the primary symptom or clinical concern reported by the patient that prompted the prior authorization request. Used by utilization management reviewers to assess medical necessity, align the request with diagnosis codes, and apply appropriate clinical coverage criteria.

The subordinate authorization record linked to a parent authorization in a hierarchical prior authorization structure. Used in utilization management systems to associate individual service-level approvals to a governing parent authorization, enabling granular tracking of multi-service or multi-episode approval relationships within payer and EHR platforms.

Stores the city associated with the location where authorized services are to be delivered or where the requesting provider is based. Used in utilization management and network management systems to verify in-network status, apply geographic coverage rules, and support care coordination.

Records the date a claim was submitted for services rendered under a prior authorization. Used in claims adjudication workflows to verify that billing occurred within the authorization's approved service window and to reconcile authorized episodes of care with received claims.

Indicates the current adjudication state of a claim associated with a prior authorization, such as pending, paid, denied, or appealed. Used in utilization management and claims systems to monitor whether authorized services were billed, processed, and reimbursed as approved.

The classification tier assigned to a prior authorization indicating the category of service approved, such as inpatient, outpatient, specialty, or behavioral health. Referenced in utilization management and claims adjudication systems to apply appropriate review criteria, routing rules, and reimbursement policies for each authorization class.

The unique alphanumeric identifier assigned by a payer to confirm approval of a prior authorization request for specific healthcare services. Referenced across EHR, claims adjudication, and utilization management systems to validate service eligibility during billing, preventing claim denials due to missing or mismatched authorization identifiers.

Free-text notation field attached to a prior authorization record in EHR, utilization management, and payer adjudication systems. Captures clinical rationale, reviewer notes, or denial reasons. Used by care managers and data engineers when auditing approval workflows or building authorization analytics pipelines.

Records the date on which all services approved under a prior authorization were fully delivered and the authorization episode was closed. Used in utilization management systems to confirm care completion, trigger post-authorization reviews, and support outcomes tracking and reporting.

Flag identifying whether a prior authorization request contains sensitive or restricted clinical information, such as behavioral health, substance abuse, or HIV-related services, requiring limited access controls within utilization management and claims adjudication systems.

Numeric aggregate of prior authorization records associated with a member, provider, service type, or time period within utilization management and claims adjudication systems. Used by data engineers in reporting pipelines to measure approval volumes, denial rates, and utilization trends across payer, PBM, and EHR data sources.

The country where the authorized medical service is requested or to be rendered, used in utilization management systems to apply jurisdiction-specific coverage rules and coordinate benefits for members receiving care abroad or in cross-border health plan arrangements.

The user ID or system identifier of the individual or automated process that originated the prior authorization record in the utilization management system, supporting audit trails, accountability tracking, and workflow management for clinical review teams.

The timestamp recording when a prior authorization request was first entered into a utilization management, EHR, or payer adjudication system. Critical for SLA tracking, turnaround time calculations, and audit trails. Used by data engineers to sequence authorization lifecycle events and support compliance reporting in claims and care management pipelines.