I would define what changed and when
The review would begin with a defined procedure or treatment population and a comparison between the approved scope and the actual service. I would identify which changes the organization expects staff to review and which the payer requires to be updated. The authorization number alone is insufficient if the surrounding approved details no longer match.
I would preserve the timeline: original request, payer decision, order or scheduling changes, additional payer contact, service, and claim submission. A change made before the initial request is different from a change made after approval. Without that sequence, the report can label a necessary revision as an error or miss an unreviewed late change.
The Epic review should follow the order and linked authorization
In Epic, I would review the order, associated referral or authorization record, scheduled encounter, and the relevant coverage. The application team should explain how the selected workflow evaluates authorization requirements for changed orders and how statuses signal that a new review is needed. I would verify the local behavior rather than assume every order change automatically creates an appropriate task.
Treatment plans and other specialty workflows can introduce additional relationships and quantity tracking. I would keep those scenarios separate until the clinical and authorization teams confirm the intended process. A configuration that works for a single imaging order may not represent the needs of an ongoing treatment course.
What I would request for a useful sample
I would request original and revised order details, scheduled and performed service information, payer and plan, authorization status history, approved dates and units where applicable, linked records, and payer correspondence. I would include denied cases and cases that were revised successfully so the review can identify the control that worked as well as the one that failed.
The build request would include the relevant payer and plan requirements, procedure grouping, status configuration, and workqueue selection rules. Where CER rules contribute, I would ask for their context, criteria, property parameters, and where-used information. That inventory would be paired with the representative account timeline because configuration alone cannot establish what the user knew at the time.
The change needs a visible review path
I would work with scheduling, clinical operations, and authorization staff to define who identifies each qualifying change and who contacts the payer. The handoff should carry the changed detail, the prior approval, the service timing, and the decision needed. Sending an account back with an undefined authorization problem makes the receiving team repeat the investigation.
The department also needs a clear operational decision when the issue remains unresolved near service. That decision belongs to the organization’s approved access and clinical policies, with appropriate escalation. I would not build a universal cancellation rule or treat an administrative approval as a clinical judgment.
The test should include a valid approval that becomes outdated
I would test a service that remains within the approved scope, a revised procedure, a moved service date, a coverage change, and a quantity increase where relevant. The expected result would identify whether the system should produce an exception, update a status, preserve the existing approval, or require a documented review.
Then I would test the return path after the payer confirms the revision. Staff should be able to establish what was approved, what was reviewed, and why the account no longer needs action. The test also should include a change that does not require a new approval so that the design does not generate unnecessary repeat work.
I would measure mismatches and the speed of the response
The denominator should be encounters or orders exposed to a qualifying post-approval change, not every scheduled service. I would track the incidence of changes separately from failure to review them. Otherwise, a department with more clinically appropriate revisions can appear less effective simply because its work is more complex.
| Measure | How I would use it |
|---|---|
| Review completion | Qualifying changes with the required documented review completed by the agreed decision point. |
| Change-to-review time | Elapsed time from the change to an actionable authorization decision, segmented by change type. |
| Approval-to-service match | Reviewed services whose performed details agree with the confirmed authorization scope. |
| Downstream outcome | New denials and final losses attributable to confirmed scope mismatches, using mature service cohorts. |
I would report avoidable repeat contacts and late schedule disruption alongside the financial measures. Fewer authorization mismatches can improve payment reliability, but the project should demonstrate that improvement through the affected claims rather than apply the entire procedure charge as a savings amount.