---
schema_version: "1"
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title: Authorization Request Process Flow in a Provider’s Office
collection: admin
version: current
locale: en-us
portal_url: https://docs.salesforce.com/admin/current/en-us/ind/264-0-0/admin_utilization_management_provider_flow.md
canonical_url: https://help.salesforce.com/s/articleView?id=ind.admin_utilization_management_provider_flow.htm&release=264.0.0&type=5
source_site: help.salesforce.com
content_type: documentation
content_hash: bb0fc9de18b6c8dc42b05c430338707c0ebaa578a88012bf23dc3cef1700c925
description: Utilization Management’s solution for providers gathers necessary clinical information from the Electronic Health Record (EHR) system and establishes a connection with the clearing house or payer system. With this seamless integration, provider users can efficiently create and submit authorization requests and deliver timely care to patients.
products:
  - Health
release: "264"
---
# Authorization Request Process Flow in a Provider’s Office

Utilization Management’s solution for providers gathers necessary clinical information from the Electronic Health Record (EHR) system and establishes a connection with the clearing house or payer system. With this seamless integration, provider users can efficiently create and submit authorization requests and deliver timely care to patients.

### Required Editions

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            <p>Available in: Lightning Experience</p>
            <p style="margin-bottom:0;">Available in: <strong>Enterprise</strong> and <strong>Unlimited</strong> Editions with Health
              Cloud</p>
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When a patient books an appointment or visits a provider, the patient’s diagnosis and service information are updated in the EHR. Before the provider can proceed with the treatment for the patient, an authorization request must be submitted to the payer. The authorization coordinator on staff at the provider’s office is responsible for handling the end-to-end authorization process of the patient’s services. On receiving an approval for the requested services from the payer, the provider can proceed with care delivery.

Let’s see how authorization coordinators manage requests:

1. View and retrieve patient information, clinical data (diagnosis and service), requesting and servicing provider details, and more from the EHR system.
2. Check if authorization is necessary for the requested services or diagnosis from the payer.
3. Create and submit authorization requests with the necessary details and documents to the payer based on the defined requirements.
4. Follow up on the status of the submitted request.
5. Provide additional information to the payer to enable prompt decision making.
6. Receive the determination in a timely manner so that patient care is delivered as planned.
7. After the request is approved, submit approval reference details to the payer for processing claim submissions. If the request is denied, raise an appeal request with the payer for reconsideration or request a peer-to-peer meeting.

#### See Also

- [Utilization Management Setup Checklist](https://help.salesforce.com/s/articleView?id=ind.admin_utilization_management_setup_checklist.htm&release=264.0.0&type=5 "To get started with Utilization Management setup, complete prerequisites such as enabling person accounts, installing Omnistudio, ensuring you have the correct permission sets and permission set licenses, and setting up the relevant data in your org.")
- [Authorization Request Process Setup for Providers](https://help.salesforce.com/s/articleView?id=ind.admin_utilization_management_provider_setup.htm&release=264.0.0&type=5 "Help your provider users to easily create and submit authorization requests using FHIR-aligned, industry-specific APIs, along with a predefined suite of Integration Procedures and Omnistudio Data Mappers. These components retrieve member information, service requests, and other details required to create an authorization request record and submit the request to the payer.")
- [Manage Care Requests](https://help.salesforce.com/s/articleView?id=ind.landing_utilzation_management.htm&release=264.0.0&type=5 "Give your users the tools to collaborate seamlessly when they submit, assign, or process requests for coverage requirements discovery (CRD), documentation templates and rules (DTR), and prior authorization support (PAS). Utilization Management makes it easier for provider and payer organizations to gather member and clinical data, streamline request reviews, and evaluate requests for medical necessity.")
- [_Salesforce Help:_ Business Rules Engine Use Cases](https://help.salesforce.com/s/articleView?id=ind.bre_usecase_scenarios.htm&language=en_US)