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Janus Health says its prior-authorization workflow can submit authorization for rendered services that were not included in an original approval. That post-service submission must retain the original decision, actual service, added scope, payer response, and claim relationship without implying retroactive approval, coverage, or payment.
Evolent presents specialty care-management programs that can combine clinical pathways, prior authorization, provider engagement, peer review, analytics, and value-based models. When a plan delegates review activity, the case record still needs to identify which organization and qualified reviewer held authority for the particular specialty, benefit, member, request, and decision date.
Infinx describes prior-authorization workflows that obtain approvals and send an approval package back to the electronic medical record. That handoff can reduce manual retrieval, but the organization still needs to prove that the authorization matches the patient, benefit, service, units, dates, provider, facility, and schedule that will actually be used.
