THE DESK REFERENCE
Prior Authorization Follow-Up: Questions to Ask the Plan
The purpose of a status call is to find out what the plan knows and what your team should do next. This administrative checklist helps organize that conversation; it does not establish coverage, clinical necessity, or a decision deadline.
Start with the right department.
Find published phone, fax and email routes, with source dates and plan-specific details.
Find authorization contactsStart with the exact request
Have the case number if one exists, the submission date, the requested service, and the intended service date. Confirm that the representative is looking at the same patient and request before discussing the status.
- Identify the request and submission route.
- Ask whether the plan received it.
- Confirm which service, provider, and date range the record describes.
- Record the case identifier supplied by the plan.
Make “pending” more specific
Pending can mean different things within a payer’s process. Ask what step the request is in and whether anything is missing. Capture the representative’s actual explanation without inventing a reason or treating a general timeline as a guaranteed decision date.
- Ask what the current status means for this request.
- List missing documents or corrections separately.
- Confirm where and how the practice should supply each item.
- Ask for the appropriate next follow-up date or route.
Know when to bring in a clinician
An administrative assistant can organize the call and record the plan’s requirements. Questions requiring clinical interpretation, medical necessity, or a peer-to-peer discussion belong with the appropriate clinician.
- Record the clinical review contact and scheduling process.
- Identify the person in the practice who should receive the handoff.
- Keep the authorization status separate from a clinical recommendation.
- Escalate urgent clinical concerns through the practice’s established process.
Close with a usable handoff
Before ending, summarize what the plan confirmed and what the office still needs to do. The next person should be able to understand the situation from the record without replaying an entire conversation.
- Save the representative and call reference.
- Record each outstanding item with an owner.
- Include the follow-up timing exactly as stated.
- Reconcile the call with written payer evidence before relying on an approval.
Put the checklist to work.
See how an assistant can handle the call brief, the wait, and the outcome record while your team keeps control.
Explore the workflow