Prior Authorization

Type: Information Object

Status: Planned
Industry Sector: Healthcare
Sensitivity Level: Confidential
Personal Information: Sensitive PII

Description:
Authorization from a payer for a healthcare service before delivery or reimbursement.

Accessed by Application(s):

• Clinical Decision Support System
• Prior Authorization Management System
• Revenue Cycle Management System

 Yes

Attributes

Order	Name	Description	Type	Cardinality	Example value
1	Prior Authorization ID	Unique identifier for the prior authorization	GUID	Mandatory
2	Patient ID	Reference to the patient receiving the authorized service	Reference	Mandatory
3	Requested Service	Healthcare service requiring authorization	String	Mandatory
4	Payer Name	Name of the payer or insurer	String	Mandatory
5	Request Date	Date when authorization was requested	Date	Mandatory
6	Authorization Status	Current authorization decision status	Enumeration	Mandatory
7	Decision Date	Date when the authorization decision was made	Date	Optional
8	Authorization Number	Identifier issued by the payer	String	Optional

 Yes
 
 Planned
 Sensitive PII
 Confidential
 Healthcare
 Authorization from a payer for a healthcare service before delivery or reimbursement.

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