Prior Authorization Automation: Get Requests Submitted and Decisions Back

A patient needs a procedure, treatment, or medication. The order is in the chart. Before care can move forward, someone has to determine whether authorization is required, collect the supporting records, submit the request, and keep checking until the payer responds.

That work often stretches across an EHR, payer portals, uploaded documents, fax, and phone calls. A submitted form is only one part of the job. Your team needs the decision, the relevant authorization details, and a clear view of anything still holding up the request.

Champ automates that administrative work: preparing requests, submitting them through the payer’s required channel, following up, and recording the response in your existing system.

What is prior authorization automation?

Prior authorization automation handles the administrative steps involved in obtaining a payer’s decision before certain services or medications are provided. It connects the information in the patient’s chart with the payer’s submission and follow-up process.

Prior authorization is different from checking whether insurance is active. Eligibility verification establishes coverage and benefits; authorization addresses whether a particular service or medication requires advance review. HealthCare.gov’s definition of preauthorization also makes an important distinction: authorization does not guarantee payment.

The useful outcome is a complete request that keeps moving, with the payer’s response available to the people arranging care.

Get the right request prepared

Authorization requirements can depend on the patient’s plan, the requested service or medication, the provider, and where care will take place. Champ checks those details against the relevant payer requirements before preparing the submission.

It can gather the order, diagnosis information, existing chart notes, treatment history, and other supporting records from your systems. When the payer requires specific documentation, Champ assembles what is available and identifies what is missing.

For example, a request might need a recent note or evidence of previous treatment that is stored elsewhere in the chart. Collecting those records before submission can prevent a request from sitting unanswered because an attachment was left out.

Champ uses the clinical documentation your team has already created. If the record is incomplete or a question requires clinical judgment, it brings that question back to the appropriate staff instead of inventing an answer.

Get requests submitted across payer systems

Payers do not all use the same forms, portals, or submission methods. Your team may work with one portal for medical services, another for pharmacy requests, and a different process for a particular plan.

Champ completes the required forms, attaches supporting records, and submits through the appropriate channel, including browser-based portals and fax where accepted. It captures the submission confirmation and reference number so the request can be found again.

Payer-specific requirements still matter. For example, UnitedHealthcare’s prior authorization resources describe online submission and status tools, while also directing providers to verify the clinical requirements for each request.

The result is a submitted request with the supporting information and confirmation recorded, without staff repeatedly copying the same details between systems.

Keep following up until there is an answer

Submission does not tell your team whether the payer has everything it needs. A request may be pending, awaiting an attachment, or returned for additional information.

Champ checks the status and follows up on routine administrative requests. If the payer needs an existing document, it can retrieve and submit it. If a form needs an administrative correction, it can update the information and continue the request.

When the portal is inadequate, Champ can make phone calls. It can contact the payer to clarify the status, confirm receipt of records, ask what is missing, and obtain a reference number or stated next step.

That matters when an online status says little more than “pending.” Your team needs to know whether the request is under review, whether something is missing, or whether someone needs to act. Champ records the answer and continues the administrative follow-up, bringing clinical questions to your staff when needed.

Put the decision back in the EHR

A payer response is most useful when it is attached to the patient’s record and available where your team already works.

Champ records the decision and its supporting details, such as the authorization number, covered service or medication, approved dates, units or visits, and any conditions stated by the payer. It can also save the decision letter or other supporting documentation.

Those details help staff determine whether the response matches the planned care. An approval for a different service, location, or date range still needs attention before the team relies on it.

If the request is denied or requires clinical review, Champ records the reason and the payer’s stated next steps for your team. Clinicians and authorized staff retain responsibility for medical-necessity arguments, peer-to-peer reviews, and appeal decisions.

Work with the EHR and systems you already use

Champ can integrate with any EHR or other system your team accesses through a browser. It can read the relevant information, complete forms, upload documents, and write updates back without requiring a prebuilt connector or an available API.

That makes the workflow practical across the tools involved in authorization: the EHR that holds the clinical record, the payer portal that accepts the request, and the practice management system used by administrative staff.

Phone calls extend that work when the online process cannot provide an answer. Your team can keep its existing systems while Champ handles the repetitive work between them.

For the coverage checks that often come before authorization, see our guide to insurance eligibility verification automation.

Where the impact is greatest

Prior authorization automation is especially relevant when staff spend a large part of their day preparing requests and checking on them: specialty practices, imaging centers, infusion providers, therapy organizations, and other teams coordinating authorization-dependent care.

The opportunity grows with the number of payers, locations, and requests your team handles. Each additional portal or follow-up call creates administrative work that can compete with patient communication and scheduling.

The outcomes to look for are concrete: fewer requests waiting on available records, less staff time spent checking status, and payer decisions documented where the team can use them.

Frequently asked questions

Can Champ handle both medical and medication prior authorizations?

Champ can support medical and medication authorization workflows, using the relevant payer forms, portals, and supporting documentation. The specific process depends on the service, plan, and systems your organization uses.

What happens when the payer needs more information?

Champ can retrieve and submit existing records and answer routine administrative questions. Requests for new clinical information, attestations, or medical-necessity judgments go to your authorized staff.

Can Champ call an insurance company?

Yes. When the portal does not provide enough information, Champ can call the payer to check status, confirm receipt, or clarify what is needed, then document the response in your system.

Does automation guarantee approval?

No. The payer makes the authorization decision. Champ handles the administrative work of preparing, submitting, following up, and documenting the result; it does not promise approval or payment.

Get prior authorizations moving

Your team should be able to find out what was submitted, what the payer needs, and what decision came back without retracing every portal visit and phone call.

Explore Champ’s prior authorization automation, or book a demo to see how Champ can prepare requests, follow up with payers, and bring decisions back into your existing systems.