Scheduling a procedure that needs insurer pre-approval now triggers a flow that assembles clinical notes, imaging reports, and billing codes into a complete prior-auth packet, files it with the payer, and chases the request until a decision lands.
Typical results
15 min
Packet assembly
-82%
Resubmissions
100%
Requests tracked
Figures reflect typical results for this kind of automation.
The challenge
Every insurer-approved procedure began with a scavenger hunt: staff chased surgeons for notes, radiology for reports, and billing for codes, then faxed packets that came back for missing pages. Approvals dragged for weeks, surgery slots sat empty waiting on decisions, and nobody knew which of forty open requests had stalled at the payer.
Before and after
Approval turnaround
−56%Packet assembly time
−83%Resubmissions per month
−82%The automation
We built a Make flow that fires the moment a procedure requiring pre-approval is scheduled. It pulls the clinical notes, imaging reports, and CPT and ICD codes from the practice systems, checks them against each payer's checklist, and assembles a complete submission packet. The packet files automatically with the insurer, every request gets a tracked status in the CRM, and the flow follows up on schedule until a decision arrives — escalating stalled cases to staff.
How it works
- 01
Procedure scheduled
Booking a procedure that needs insurer pre-approval triggers the flow automatically.
- 02
Packet assembled
Clinical notes, imaging reports, and CPT and ICD codes are pulled and checked against the payer's checklist.
- 03
Filed with the payer
The complete packet submits to the insurer with a confirmation logged to the CRM.
- 04
Status tracked
Every open request carries a live status, with follow-ups fired on schedule until a decision lands.
- 05
Stalls escalated
Requests that go quiet at the payer are flagged to staff before they cost a surgery slot.
Starts from
- Clinical notes & codes
- Imaging reports
Delivers
- Payer submission
- Stalled-case alerts
- Tracked request status
The impact
Average approval turnaround dropped from sixteen days to seven — nine days faster — and packets that took ninety minutes to compile now assemble in fifteen. Resubmissions for missing documents fell by over 80%, no request goes silent anymore, and the surgical schedule fills with confirmed cases instead of holds.
Questions about this automation
What triggers a prior authorization packet?
The flow starts as soon as a procedure that requires insurer pre-approval is scheduled. It pulls the clinical notes, imaging reports and CPT and ICD codes from the practice systems, so staff no longer have to chase surgeons, radiology and billing for each piece of the packet.
How does the flow catch missing documents before submission?
Each payer's requirements are stored as a checklist. The assembled packet is checked against that list before it is filed, and any missing note, report or code is flagged to staff to complete. Only packets that pass the checklist are submitted, which cuts the back-and-forth caused by incomplete requests.
How are open requests followed up?
Every submitted request gets a tracked status in the CRM. The flow sends follow-ups on a set schedule until the payer issues a decision, and requests that go quiet for too long are escalated to staff before they put a surgery slot at risk. Decisions are recorded against the scheduled procedure.