What comes in
Service ordered
- Authorization required
- Supporting note available
Prior AuthorizationIn beta
Keep prior authorizations moving, with fewer status checks.
Caesar prepares prior authorization requests with the supporting records and tracks the response. Your team can see the information a payer needs and which cases require clinical review.
- Tracks the request after submission
- Shows missing information that needs attention
See the work
Know what is holding up the request.
Illustrative authorization workflows. The payer makes the decision in each case.
What comes next
Request submitted
- Required fields completed
- Payer reference recorded
The pending request stays in the follow-up queue.
What Prior Authorization does
- 1Check plan
- 2Gather records
- 3Submit request
- 4Track response
What comes in
Payer response
- Additional documentation requested
- Request remains pending
What comes next
Review task
- Requested record identified
- Assigned to the care team
Staff can see the missing item and the next action.
What Prior Authorization does
- 1Read response
- 2Identify gap
- 3Staff review
- 4Send update
What it handles
The paperwork has a next step.
Prior Authorization is part of Caesar's Revenue Cycle agent. It follows the administrative work around an ordered service, using your payer connections and review process.
Check the requirement
Compare the ordered service with available payer and plan rules to identify when authorization is needed.
Build the request
Complete the required fields and gather supporting clinical records. Flag missing information before it holds up the request.
Track the response
Follow submitted requests and surface a payer's request for additional information to your team.
Prepare an appeal
Organize the denial reason and supporting documentation into an appeal draft for the appropriate review.
Fits your practice
Follow the request to a recorded decision.
Set up the payer workflows you use most. Each case retains its submission details and follow-up history.
- 1
Check the order
Identify the applicable authorization requirement for the service and plan.
- 2
Collect the evidence
Attach existing clinical documentation and flag any missing records.
- 3
Submit and follow up
Use supported payer connections and track requests that remain pending.
- 4
Notify the team
Record the payer response and route any clinical questions for review.
The payer decides. Your clinician reviews the clinical case.
Caesar manages the request and supporting paperwork. It does not decide medical necessity or guarantee approval. Cases needing clinical judgment, including appeal rationale, stay with qualified staff.
- Clinical review stays with your team
- Approval timing depends on the payer
Keep your existing system.
We confirm the available connections and functions in your electronic medical record system, or EMR, before setup.
Check your EMR integration
Available functions vary by system and agent.
Before you start
Your questions, answered.
What to expect from Prior Authorization, and what your team controls.
How is this different from the full Revenue Cycle agent?
Prior Authorization handles requirements, submission and follow-up before care. Coding & Billing, Denial Management and Payment Posting handle the later parts of the same Revenue Cycle platform. An approved authorization can be carried into claim preparation.
How much faster are approvals, really?
Caesar reduces manual request preparation and follows up on pending cases. Complete requests can enter the submission workflow without waiting for another manual status check. The payer controls turnaround and approval, so we do not guarantee a decision in hours.
What happens when a payer denies the authorization?
The workflow prepares an appeal using the denial reason and supporting clinical documentation. Your designated reviewer checks the clinical rationale, then the supported workflow submits and tracks the appeal to a recorded decision.
Does it know which services need a prior auth?
It checks ordered services against available payer- and plan-specific requirements. Medical-necessity criteria help identify the supporting records a payer requests. The clinician remains responsible for the clinical case.
Which payer systems does it work with?
Supported connections include major payer PA portals and electronic prior authorization systems. Clinical records can come from Epic, athenahealth, eClinicalWorks and NextGen. We check your portals and define how unsupported steps reach staff.
Is the Prior Authorization function HIPAA compliant?
Yes. The Prior Authorization function runs on HIPAA-compliant infrastructure. Each request retains a complete, time-stamped audit trail. Caesar Health executes a Business Associate Agreement (BAA) at contract signing. SOC 2 Type II is in progress.
What documentation and status details does it keep?
Requests include patient demographics and the relevant clinical notes, lab results or imaging. Submission details, follow-up actions and payer responses stay together. Providers are notified when approval arrives or more information is needed.
Is Prior Authorization live or in beta?
It is in beta. We confirm payer connections and documentation needs before choosing the first workflows, including the points requiring staff review.
Prior Authorization
Bring your most time-consuming authorization workflow.
We will map the request and the follow-up work, including where your clinical team needs to review.
Book a demo