Connect the review, the chart, and the decision
- Queue the review
- Ease Health queues authorization reviews after admission and changes in level of care.
- Prepare the records
- Teams can prepare a renewal call sheet and a payer packet from the chart. The clinical reviewer confirms the evidence.
- Record the outcome
- The authorization team records the payer’s decision. Billing can review the recorded approval alongside the encounter.
Test a renewal when the payer changes the dates
Use this fictional IOP case in each vendor demo. Follow one request through receipt, a correction, and a decision that covers a different period from the one requested.
October 9
Renewal requested
The current approval ends October 14. The team requests eight sessions from October 15 through 28.
Demo check. Find the open request and confirm its owner, dates, and requested quantity.
October 12
Receipt confirmed
The payer confirms receipt. The recorded approval still ends October 14.
Demo check. Show receipt and the current authorization as distinct records or statuses.
October 14
More information requested
The payer asks for a corrected progress note for the review period.
Demo check. Find the requested note and show how the clinical reviewer takes ownership.
October 15
Updated packet sent
The clinician confirms the signed correction. The team sends an updated packet.
Demo check. Identify the version sent and the owner of the pending response.
October 16
Decision received
The notice approves six sessions from October 16 through 25. The sample patient attended on October 15.
Demo check. Use the notice dates and route the October 15 encounter to the billing reviewer.
October 21
Replacement notice received
The payer extends the end date to October 26 and revises the same approval to seven sessions total.
Demo check. Show the latest scope and the prior notice. Confirm the recorded quantity is seven sessions.
Download the six-check utilization review scorecard (CSV). Record the evidence each vendor shows and who would own any follow-up.
Check how requests and decisions travel
CMS-0057-F phases in prior authorization requirements for impacted payers. The rule’s API requirements generally begin in January 2027. In a demo, ask which request and response channels work for your payers and who handles a request for more information. Read the CMS final rule fact sheet.
For the underlying work, see the IOP and PHP evidence packet guide and the authorization dates and units guide. Use the IOP and PHP software overview to evaluate the wider handoff.
Frequently asked questions
What can utilization review software automate for IOP and PHP?
Ease Health queues authorization reviews after admission and level-of-care changes, prepares a renewal call sheet and payer packet from the chart, and records approved or denied renewal outcomes.
Who decides whether a continued-stay request is approved?
The clinician reviews the clinical evidence and the payer issues its decision. The authorization team records the dates, services, and quantity the payer approved so billing can compare the decision with the encounter.
How should I compare a renewal request with the approval notice?
Check the dates, program, and units on the decision against the original request. Keep a replacement notice tied to the same authorization and give any affected encounter to the authorization and billing owners for review.