Operations

The date on which a prior authorization or service approval expires, ending the payer's permission for the authorized service. Used in utilization management systems to enforce approval windows and flag claims submitted after the authorized period ends.

Records the specific time of day a prior authorization or permission grant was approved within claims, PBM, or EHR systems. Used in audit trails and SLA reporting to measure turnaround times for authorization decisions against regulatory benchmarks.

Captures the full date and time a prior authorization or claim approval decision was recorded in claims, PBM, or utilization management systems. Critical for audit compliance, SLA tracking, and determining authorization validity windows within adjudication pipelines.

The formal name or label assigned to a prior authorization record, identifying the specific service, procedure, or treatment approved by the payer. Used in utilization management workflows to distinguish authorization types and support member care coordination.

Represents the aggregated monetary or unit sum associated with an approved prior authorization or claim permission in PBM or claims systems. Used to enforce benefit limits, track authorized spend, and reconcile approved quantities against actual utilization during claims adjudication.

The total number of approved service units, visits, or occurrences granted under a prior authorization. Used in utilization management to enforce limits on approved services and track consumption against authorized quantities in claims adjudication.

Classifies the category of a prior authorization or permission grant in claims, PBM, or utilization management systems. Common values include prior authorization, concurrent review, retrospective review, or formulary exception, driving downstream adjudication and workflow routing logic.

Specifies the measurement unit—such as days, doses, visits, or units of service—associated with an approved prior authorization in PBM or utilization management systems. Used to enforce quantity limits and validate claim submissions against authorized service volumes.

The most recent date on which a prior authorization record was modified, such as when a payer amended approved units, extended an end date, or changed authorization status. Used to audit authorization changes and maintain accurate utilization management records.

The time sensitivity classification assigned to a prior authorization request, such as routine, urgent, or emergent. Payers use this value to determine review turnaround time requirements under utilization management guidelines and regulatory compliance standards.

Represents the specific quantitative or coded data point tied to a prior authorization or permission grant in claims or PBM systems, such as an approved dollar amount or unit count. Used in adjudication to validate claims against approved thresholds and enforce benefit limits.

The sequential version number of a prior authorization record, incremented each time the authorization is amended or updated by the payer. Used in utilization management systems to maintain a full audit trail of authorization changes and support claims adjudication accuracy.

The postal code associated with the service location or rendering facility specified in a prior authorization. Used in utilization management and claims processing to validate that services were rendered at the authorized location and support geographic reporting.

The physical location where a clinical assessment was conducted, including facility or home address details. Used in care management and clinical documentation systems to record where patient evaluations occurred, supporting care coordination and population health reporting.

The current authorization or review state of a clinical assessment, such as pending, approved, or denied. Used in care management workflows to track whether an assessment has received required clinical or administrative sign-off before results are acted upon.

The billed charge associated with administering a clinical assessment, representing the provider's stated fee before payer adjustments. Used in claims and care management financial reporting to track assessment-related costs and support revenue cycle analysis.

The date on which a clinical assessment becomes active or valid for use in care planning and clinical decision-making. Used in care management systems to establish the timeframe during which assessment results are considered current and actionable for treatment decisions.

The insurance group identifier linked to a member at the time a clinical assessment was conducted. Used in care management and claims systems to associate assessment records with the correct employer group or health plan contract for billing and reporting purposes.

The unique patient medical record number assigned by a healthcare facility, linked to a clinical assessment record. Used to associate assessment data with the correct patient across EHR and care management systems, ensuring accurate longitudinal health record tracking.

The calendar date on which a clinical assessment is planned to be administered to a patient. Used in care management and scheduling systems to coordinate patient outreach, clinician availability, and follow-up workflows for structured health evaluations.