Pre-Authorizations
Request and manage insurance pre-authorizations for services requiring prior approval
Overview
Pre-authorizations (prior approvals) are required by many insurance companies before certain medical procedures, surgeries, or expensive tests can be performed. SehaFile's pre-authorization module lets you request approvals, track their status, verify existing authorizations before scheduling services, and bulk-update multiple authorizations when responses arrive from insurers.
Requesting a Pre-Authorization
- Navigate to Authorizations: Go to Insurance > Authorizations from the sidebar and click + New Authorization.
- Select Patient: Choose the patient who needs the pre-authorized service.
- Select Insurance Company: The system auto-fills this from the patient's insurance profile. Verify it is correct.
- Enter Service Details:
- Service Type (نوع الخدمة) - e.g., surgery, imaging, procedure
- Service Code (كود الخدمة) - The specific code from the insurer's catalog
- Service Name (اسم الخدمة) - Human-readable name for reference
- Add Notes: Include clinical justification or any relevant medical history that supports the request.
- Submit: Click Request Authorization. The system creates the request with status "pending" and records the requesting user and timestamp.
Checking Existing Authorizations
- Quick Check: Use the authorization check endpoint by navigating to a patient's profile and clicking Check Authorization.
- Enter Service Code: Type the service code you want to verify.
- View Result: The system searches for an approved, non-expired authorization for that patient and service code. It returns either:
- Authorized - with the authorization number and expiry date
- Not Authorized - no valid authorization found
Bulk Updating Authorization Statuses
- Select Multiple: In the authorizations list, check the boxes next to multiple pending authorizations.
- Click Bulk Update: Click the Bulk Update button in the toolbar.
- Set New Status: Choose "approved" or "denied" from the status dropdown.
- For Approvals: Enter the Authorization Number and Expiry Date provided by the insurer.
- For Denials: Enter the Denial Reason.
- Confirm: Click Update All. All selected authorizations are updated simultaneously.
Tip: Always check for existing authorization before scheduling expensive procedures. This prevents claim rejections later. The check is quick - it queries by patient ID and service code.
Warning: Expired authorizations are not valid. The system checks the expires_at date - if it has passed, the authorization is treated as non-existent. Request a new one.
Pre-authorization request form and list view showing status badges (pending, approved, denied) with bulk update toolbar
Frequently Asked Questions
Who can request pre-authorizations?
Users with admin, accountant, or doctor roles can create authorization requests.
How long are authorizations valid?
Validity depends on the insurer. When updating status to "approved", you must enter the expiry date as communicated by the insurance company.
What if the authorization is denied?
The denial reason is recorded. You can discuss alternative approaches with the patient (self-pay, different procedure) or submit a new request with additional clinical justification.
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