Clinical documentation is critical for all authorization requests, including preservice elective inpatient procedures

Submitting properly documented clinical information with your authorization requests ensures accurate evaluation and facilitates effective, timely decision making. Without it, the review process can be significantly delayed or result in a denial.

How to ensure proper clinical documentation with every request

With each request, submit clinical documentation that is:

  • Complete: Include clinical notes, test results, imaging reports and any other pertinent information.
  • Relevant: Clinical records must be up-to-date and address the specific criteria outlined for the requested service.

Additionally, we strongly encourage you to include your direct contact information – name and phone number – when submitting requests. This allows us to reach you quickly for any additional information needed during the review process.

Get more information

For additional details on submitting elective inpatient prior authorizations, see our guide. Guides for each authorization type are available through prism, our provider portal:

  1. Log into your prism account.
  2. Under the Authorization menu, click Request an Authorization.
  3. On the resulting page, click Auth requests help page.

We appreciate your commitment to quality care and collaboration. By collectively adhering to these guidelines, we can streamline the review process and provide optimal outcomes for our members, your patients.