Prior-Authorization Discovery Checklist
OCiTechServices

Use this worksheet in your first clinic discovery call.

1) Clinic Profile
- Specialty mix (cardiology, oncology, GI, imaging, multi-specialty)
- Providers count and locations
- Current EHR + PM systems
- Payer mix (top 5 payers by volume)

2) Current Prior-Auth Workload
- Avg requests per provider per week
- Total requests per month
- Staff FTE involved in prior-auth operations
- Weekly admin hours spent on prior-auth

3) Bottleneck Mapping
- Intake delays (missing documentation, coding gaps)
- Form completion rework
- Attachment quality and completeness issues
- Portal switching and manual status tracking
- Denial reasons by payer

4) KPI Baseline (Current State)
- First-pass approval rate
- Denial rate
- Rework rate
- Average submission turnaround time
- Appeal volume and average appeal cycle time

5) Data + Integration Readiness
- Required fields available in EHR for automation
- API access availability
- Secure document storage standards
- Audit trail and compliance requirements

6) Automation Scope (Pilot)
- Auto-fill forms
- Attachment validation
- Denial-risk flagging before submit
- Status monitoring and alerts
- Appeal packet drafting

7) Success Targets (90 Days)
- Target % reduction in admin hours
- Target improvement in first-pass approval rate
- Target denial reduction
- Target cycle-time improvement

8) Commercial Model
- Monthly subscription range
- Onboarding fee agreement
- Volume-tier assumptions
- Executive sponsor + operations owner

Prepared by OCiTechServices
Website: https://www.ocitechservices.com
Email: info@ocitechservices.com