Prior Authorization

Empowering physicians to administer the necessary care when patients need it most —without hesitation.

A phone with a green pattern on the back of it.A phone with a green pattern on the back of it.
Prior Authorization

Expedite Your Payer Approval

Learn the benefits of Prior Authorization for a fast, life saving, and cost effective insurance approval process.

Work image


Varying and ambiguous state and federal rules leave patients in the dark and providers forced to delay necessary treatment.

No Insight Patients have no insight or knowledge about approval or denial.

Up in the Air It takes days, weeks, or longer to receive a decision.

Delays Dangerous treatment delays for acute, chronic and complex conditions.

Financial and Administrative Burden Costly provider and payer misalignment.

Work image


• Da Vinci Payer Data Exchange (PDex) Prior Authorization Profile — Enables payers to communicate prior authorization decisions and any changes directly to patients.

Explanation Of Benefit Resource is used by PDex to express claims information to members with the CARIN Blue Button® FHIR® Implementation guide (CARIN BB IG).

CARIN Blue Button® IG — Can be customized to include or exclude prior authorization records:
— Pending and active decisions
— Related clinical documentation
— Forms for items and services (not including prescription drugs)

Implement CARIN BB IG
Work image


Fast Answers — Receive an answer no later than one (1) business day after a provider initiates prior authorization for the enrollee.

Clarity — Clear understanding of pending versus active decisions and related clinical documentation or forms (not including prescription drugs).
— List of approved units and services
— Approval and ending date record
— Changes of status

No Care Delays — Patients receive the right care at the right time.

Reduced Administrative Burden Healthcare providers greatly reduce operational and financial burden with quicker and automated process.

Want to have a conversation about Prior Authorization?