MANSOQ Knowledge
← Knowledge library

RCM & insurance

Submit and follow a prior authorization

Follow the request, validity, line sufficiency and response without treating a queued status as approval.

Current source · source reviewed · 7 min read

Before you begin

1. Review the draft request

Open the episode or Authorization workbench. Confirm requested services, urgency, requested amount and clinical information against the actual care plan.

2. Submit the draft

Use Submit pre-authorization when the case shows an eligible draft. The transaction is sent through the configured NPHIES workflow; inspect the exchange result after queuing.

3. Track status and clocks

Read processing outcome separately from adjudication. The authorization workbench exposes clocks, line details, exemptions and applicable turnaround rules.

The displayed 60-minute clock is a fictional teaching rule with no insurer or regulatory authority. Read stopped-by-response state separately from the elapsed-time badge.

A fictional local 60-minute teaching clock is explicitly labeled as having no insurer or regulatory authority. Its effective/stored state is stopped by response; first response and final adjudication remain distinct observations.
Read a configured teaching response clock · 2026-10-18. Current audited MANSOQ application in an isolated local synthetic training environment. A fictional local 60-minute teaching clock is explicitly labeled as having no insurer or regulatory authority. Its effective/stored state is stopped by response; first response and final adjudication remain distinct observations.

4. Check line sufficiency

Match the authorization to the performed service and inspect quantity, amount, validity and matching evidence. A header approval does not prove every line has sufficient authorized quantity or value.

The example preserves three requested visits/300 SAR and two authorized visits/200 SAR on one line. Its reference explicitly says NOT-A-PAYER-APPROVAL.

The synthetic authorization requests three visits/300 SAR and authorizes two/200 SAR on one line. Requested and authorized values and modification status are retained separately; reference says NOT-A-PAYER-APPROVAL.
Compare requested and authorized quantities · 2026-10-18. Current audited MANSOQ application in an isolated local synthetic training environment. The synthetic authorization requests three visits/300 SAR and authorizes two/200 SAR on one line. Requested and authorized values and modification status are retained separately; reference says NOT-A-PAYER-APPROVAL.

5. Amend or cancel explicitly

Use the amendment or cancellation workflow with the original reference. Preserve the initial request and its history instead of editing an already submitted request in place.

Queued is unresolved

The observe path does not silently stop a running clock when processing is queued. Contested timing is surfaced with its gate and work items.

Clinical versus financial responsibility

Clinicians supply clinical facts. Financial permissions for claim management and responsibility decisions are separate from clinical rights.

What the current screenshots demonstrate

These are current captures from an isolated Polyclinic training environment, using explicitly fictional insurance, response, authorization, remittance and policy fixtures. They demonstrate the displayed controls and scoped observations only. They do not establish live payer connectivity, a genuine insurer approval, regulatory qualification, production tax filing, a complete role/facility matrix or a cleared financial estimate.

Troubleshooting

The authorization looks approved but a claim line is blocked

Review the line match, dates, quantity and amount. Request an evidenced amendment or authorized review for the unmatched requirement.

Source evidence

References are pinned to the private MANSOQ source repository. Repository access is required to open these links.