Abstract: A preauthorization management system. The preauthorization management system allows a health care provider to submit a preauthorization request and track the status of the preauthorization request until a final determination is reached. Once a request has been submitted, the preauthorization management system monitors the status of the request until a final disposition is reached. The preauthorization management system documents the submission and determination process to provide a record that may be used to show an event or outcome occurred. The preauthorization management system offers a simplified and uniform system for managing preauthorization for health care services that reduces or eliminates the need for health care providers to learn diverse systems and procedures of a multitude of health insurance providers.

Abstract: A preauthorization knowledgebase system. The preauthorization knowledgebase system parses relevant information from an order submitted by a health care provider and compares that information against a set of rules used to determine whether preauthorization is required for a medical service specified in the order. The rules are arranged into various hierarchical levels from payer level to procedure level. Even if the order is incomplete, the preauthorization knowledgebase system checks as many of the hierarchical levels as possible with the information provided. The preauthorization knowledgebase system returns a result indicating whether preauthorization is required for the order and, optionally, the hierarchical level(s) requiring preauthorization.

Abstract: A preauthorization management system. The preauthorization management system allows a health care provider to submit a preauthorization request and track the status of the preauthorization request until a final determination is reached. Once a request has been submitted, the preauthorization management system monitors the status of the request until a final disposition is reached. The preauthorization management system documents the submission and determination process to provide a record that may be used to show an event or outcome occurred. The preauthorization management system offers a simplified and uniform system for managing preauthorization for health care services that reduces or eliminates the need for health care providers to learn diverse systems and procedures of a multitude of health insurance providers.