Utilization Management Intelligence

The world's best prior authorization extraction

Accelerate prior authorization workflows. Extract procedure codes, diagnosis information, clinical justification, and approval decisions from PA requests. Reduce administrative burden and speed patient access to care with structured authorization data.

prior-authorization.pdf

Viewer

JSON

authorization_number

PA-2024-789012

request_date

2024-03-15

determination_date

2024-03-18

payer

name: UnitedHealthcare, plan_name: Choice Plus PPO, phone: 1-800-555-1234

member

name: Richard A. Stevens, member_id: UHC987654321, group_number: GRP-100500, date_of_birth: 1962-07-30

provider

name: Dr. Amanda Collins, MD, npi: 1234567890, practice: Orthopedic Specialists of Boston, phone: (617) 555-4567

request

service_type: Outpatient Surgery, procedure_code: 27447, procedure_description: Total Knee Arthroplasty, diagnosis_codes: ["M17.11","M17.12"], diagnosis_description: Primary osteoarthritis, bilateral knees, place_of_service: Ambulatory Surgery Center, requested_date: 2024-04-15, units_requested: 1

clinical_justification

Patient has failed conservative treatment including physical therapy (12 weeks), NSAIDs, and corticosteroid injections. X-rays show bone-on-bone arthritis. Functional limitations include inability to walk more than 1 block.

determination

status: Approved, approved_units: 1, effective_date: 2024-04-01, expiration_date: 2024-06-30, conditions: Must be performed at in-network facility

appeal_deadline

null

{ "authorization_number": "PA-2024-789012", "request_date": "2024-03-15", "determination_date": "2024-03-18", "payer": { "name": "UnitedHealthcare", "plan_name": "Choice Plus PPO", "phone": "1-800-555-1234"}, "member": { "name": "Richard A. Stevens", "member_id": "UHC987654321", "group_number": "GRP-100500", "date_of_birth": "1962-07-30"}, "provider": { "name": "Dr. Amanda Collins, MD", "npi": "1234567890", "practice": "Orthopedic Specialists of Boston", "phone": "(617) 555-4567"}, "request": { "service_type": "Outpatient Surgery", "procedure_code": "27447", "procedure_description": "Total Knee Arthroplasty", "diagnosis_codes": [ "M17.11", "M17.12"], "diagnosis_description": "Primary osteoarthritis, bilateral knees", "place_of_service": "Ambulatory Surgery Center", "requested_date": "2024-04-15", "units_requested": 1 }, "clinical_justification": "Patient has failed conservative treatment including physical therapy (12 weeks), NSAIDs, and corticosteroid injections. X-rays show bone-on-bone arthritis. Functional limitations include inability to walk more than 1 block.", "determination": { "status": "Approved", "approved_units": 1, "effective_date": "2024-04-01", "expiration_date": "2024-06-30", "conditions": "Must be performed at in-network facility"}, "appeal_deadline": null }

prior-authorization.pdf

Viewer

JSON

authorization_number

PA-2024-789012

request_date

2024-03-15

determination_date

2024-03-18

payer

name: UnitedHealthcare, plan_name: Choice Plus PPO, phone: 1-800-555-1234

member

name: Richard A. Stevens, member_id: UHC987654321, group_number: GRP-100500, date_of_birth: 1962-07-30

provider

name: Dr. Amanda Collins, MD, npi: 1234567890, practice: Orthopedic Specialists of Boston, phone: (617) 555-4567

request

service_type: Outpatient Surgery, procedure_code: 27447, procedure_description: Total Knee Arthroplasty, diagnosis_codes: ["M17.11","M17.12"], diagnosis_description: Primary osteoarthritis, bilateral knees, place_of_service: Ambulatory Surgery Center, requested_date: 2024-04-15, units_requested: 1

clinical_justification

Patient has failed conservative treatment including physical therapy (12 weeks), NSAIDs, and corticosteroid injections. X-rays show bone-on-bone arthritis. Functional limitations include inability to walk more than 1 block.

determination

status: Approved, approved_units: 1, effective_date: 2024-04-01, expiration_date: 2024-06-30, conditions: Must be performed at in-network facility

appeal_deadline

null

{ "authorization_number": "PA-2024-789012", "request_date": "2024-03-15", "determination_date": "2024-03-18", "payer": { "name": "UnitedHealthcare", "plan_name": "Choice Plus PPO", "phone": "1-800-555-1234"}, "member": { "name": "Richard A. Stevens", "member_id": "UHC987654321", "group_number": "GRP-100500", "date_of_birth": "1962-07-30"}, "provider": { "name": "Dr. Amanda Collins, MD", "npi": "1234567890", "practice": "Orthopedic Specialists of Boston", "phone": "(617) 555-4567"}, "request": { "service_type": "Outpatient Surgery", "procedure_code": "27447", "procedure_description": "Total Knee Arthroplasty", "diagnosis_codes": [ "M17.11", "M17.12"], "diagnosis_description": "Primary osteoarthritis, bilateral knees", "place_of_service": "Ambulatory Surgery Center", "requested_date": "2024-04-15", "units_requested": 1 }, "clinical_justification": "Patient has failed conservative treatment including physical therapy (12 weeks), NSAIDs, and corticosteroid injections. X-rays show bone-on-bone arthritis. Functional limitations include inability to walk more than 1 block.", "determination": { "status": "Approved", "approved_units": 1, "effective_date": "2024-04-01", "expiration_date": "2024-06-30", "conditions": "Must be performed at in-network facility"}, "appeal_deadline": null }

Integrations

Connect Prior Authorizations across your stack

DocuPipe captures prior authorization requests and responses from payer portals, fax, or EHR systems. Extract clinical details and authorization decisions, then sync to practice management or billing systems.

Secure and Compliant

Fully secure. Always.

Your documents are your own and never shared for any reason. DocuPipe encrypts all documents in transit and at rest, and has undergone formal certification to become SOC‑2 type 2 and ISO 27001 certified. This ensures that the highest standards of information security are met. DocuPipe is both GDPR and HIPAA compliant.

Visit our security page