Source: https://ensurecare.ai/resources/media/prior-auth-missing-documentation

> EnsureCare checks payer rules before a knee MRI, asks the ordering clinician for the missing physical therapy notes, and submits a complete package.

Video · Prior auth & denials

# From a missing note to a complete prior auth

EnsureCare checks payer rules before a knee MRI, asks the ordering clinician for the missing physical therapy notes, and submits a complete package.

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## What appears on screen

1. Meet James: a knee MRI ordered by Dr. Lee for Monday at 9:00 AM. The payer requires 6 weeks of physical therapy to be documented.
2. Check payer rules. Before the visit, EnsureCare verifies eligibility and benefits and finds that the payer requires prior auth. The clinical note supports the order, but the physical therapy notes are missing, so the denial risk is high. The gap is caught before submission, not after a denial.
3. Complete the evidence. One specific request goes to the clinician in the EHR, asking for the 6 weeks of physical therapy to be documented. The prior auth package shows the order and clinical note attached and the physical therapy notes missing.
4. Submit to the payer. The complete package, with the order, clinical note, and physical therapy notes, is submitted in the payer’s required format. All payer rules are met, and the Monday visit stays on schedule.
5. Track the decision. Rules checked, gap found, evidence added, package submitted, and the payer decision tracked to the end. Approval is the payer’s decision. For denied claims, EnsureCare prepares the appeal with the evidence.

Length

0:40

Type

Video

Module

[Prior auth & denials](https://ensurecare.ai/modules/denials-prevention)

[See how prior auth & denials works](https://ensurecare.ai/modules/denials-prevention)

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