Operations

Records the exact time at which a pre-service authorization period or authorized service episode begins. Used in utilization management systems to define the valid window for authorized services and to support concurrent review scheduling and inpatient admission tracking.

The two-letter state or province code associated with the entity requesting or receiving a pre-service authorization. Used in prior authorization workflows to route requests to the correct regional payer office and validate jurisdictional coverage policies.

Current state of a pre-service authorization record within the utilization management workflow, such as submitted, under review, approved, denied, or expired. Used in payer, EHR, and claims systems to drive processing logic, member and provider notifications, and authorization lifecycle management across adjudication pipelines.

The physical street address of the facility or practitioner submitting a pre-service authorization request. Used in prior authorization workflows to verify the rendering location, confirm network participation, and ensure services are approved at the correct site of care.

The concentration or dosage strength of a medication requiring pre-service authorization, such as milligrams per milliliter. Captured during pharmacy or specialty drug prior authorization to ensure the requested strength aligns with clinical guidelines and formulary criteria before approval.

A partial sum of costs or units associated with a pre-service authorization request, representing a subset of the total authorized services. Used in utilization management to track incremental cost or visit approvals before a final authorization total is calculated and confirmed.

A system-generated unique identifier assigned to a pre-service authorization record within the utilization management or payer adjudication platform. Used to link authorization data across claims, clinical, and member systems, ensuring consistent tracking throughout the approval and appeals lifecycle.

Destination reference identifying the intended recipient, system, or service line to which a pre-service authorization applies or is routed. Used in payer and utilization management systems to direct authorization records to appropriate review queues, provider groups, or downstream claims adjudication processes within EHR and payer data platforms.

The 10-digit NUCC provider taxonomy code identifying the specialty or provider type associated with a pre-service authorization request. Used to validate that the requesting or rendering clinician has the appropriate specialty classification to perform the authorized procedure or service.

The recorded body temperature of a patient captured as part of clinical criteria submitted during a pre-service authorization request. Used in medical necessity reviews where vital signs are required to justify inpatient admissions, urgent procedures, or condition-specific prior authorization decisions.

The date on which a pre-service authorization expires or is formally closed, after which claims submitted for the authorized service will no longer be considered covered under that approval. Critical for utilization management to prevent payment of services rendered outside the authorized window.

Time-of-day value capturing when a pre-service authorization event occurred, such as submission, review completion, or status update. Used in payer and utilization management systems alongside date fields to support precise timestamping of authorization workflow events for auditing, turnaround time analysis, and SLA compliance reporting.

Combined date and time value recording when a specific pre-service authorization event was created, updated, or finalized within the utilization management system. Used in payer, EHR, and claims platforms to enable precise audit trails, regulatory compliance reporting, and turnaround time measurement across authorization lifecycle workflows.

The formal name or label assigned to a pre-service authorization request, typically describing the procedure, service, or program requiring advance approval. Used in utilization management workflows to categorize and retrieve authorization records and communicate approval details to providers and members.

Aggregate sum value associated with a pre-service authorization, such as total authorized units, visits, days, or dollar amounts approved. Used in payer and utilization management systems to enforce benefit limits, track utilization against approved quantities, and support claims adjudication validation across EHR and PBM data environments.

The aggregate number of units, visits, or services approved within a pre-service authorization. Used in utilization management to enforce limits on authorized quantities, track consumption against approved totals, and trigger reviews when authorized counts are approaching exhaustion.

Category classification identifying the nature of a pre-service authorization request, such as inpatient admission, outpatient procedure, specialty referral, or durable medical equipment. Used in payer, EHR, and claims systems to route authorization requests appropriately, apply correct review criteria, and support utilization management reporting.

Measurement unit defining the quantity metric for an approved pre-service authorization, such as days, visits, doses, or procedures. Used in payer and utilization management systems to specify authorized service quantities, enforce benefit limits, and validate claims submissions against approved units in EHR and claims adjudication workflows.

The date on which a pre-service authorization record was most recently modified, such as when units were amended, a decision was changed, or clinical documentation was added. Used in utilization management audit trails to track the history of changes made to an authorization throughout its lifecycle.

A classification indicating the time sensitivity of a pre-service authorization request, such as routine, urgent, or emergent. Determines the required turnaround time for payer review decisions under URAC and state mandates, and governs how quickly the utilization management team must respond to the submitting provider.