Authorization Review
Available to: UM Coordinator, Clinical Reviewer (RN), Medical Director (MD) Module: UM Minimum Permission: UM Authorization - Submit
Overview
The Authorization Review pane is where you confirm and submit authorization data to your connected EHR system. After a document has been processed and clinically reviewed, this pane presents a structured summary of the extracted fields, procedures, and diagnoses that will be included in the authorization, and lets you transmit it to AcuityNXT with a single click. It also supports concurrent review submissions, turnaround time tracking, and manual authorization creation.
Use this feature when you need to:
Build and submit a new prior authorization to your EHR system
Prepare a concurrent review submission for an existing inpatient authorization
Review and confirm extracted data before it is transmitted externally
Track authorization turnaround time against regulatory deadlines
Create a manual authorization when no incoming document is available
[Screenshot: The Authorization Review pane showing member and provider details, a procedures list with CPT codes, a diagnoses list with ICD-10 codes, a reviewer assignment dropdown, and the Confirm & Send button at the bottom]
Before You Begin
Make sure the following are in place before submitting an authorization:
Note: The Authorization Review pane and the Create Authorization button are available only to payer organizations. Provider organizations do not submit authorizations through Lilee; their workflow focuses on receiving and responding to payer decisions (approvals, denials, and clinical requests).
Understanding Authorization Types
Lilee supports two primary authorization types, selectable through the Auth Type toggle in the Authorization Review pane:
Inpatient
IP
Authorizations for hospital admissions, inpatient stays, and bed day approvals. Typically involves a start date, end date, and number of approved bed days.
Outpatient
OP
Authorizations for outpatient procedures, therapies, diagnostic services, office-based treatments, and DME. Typically involves specific procedure codes, units, and visit counts.
The auth type determines the fields available for submission, the unit type options (bed days, units, or visits), and how the authorization is structured when it reaches your EHR system.
Step-by-Step: Submitting an Authorization
Step 1: Open the Authorization Review Pane
Select a document from the Intake Dashboard that has completed clinical review.
Click the Authorization Review toggle in the toolbar to open the pane.
The pane displays the extracted data organized into selectable sections, pre-populated from the AI extraction.
[Screenshot: The toolbar with the Authorization Review toggle highlighted, and the pane open showing the initial field selection view]
Step 2: Set the Authorization Type
Use the Auth Type toggle at the top of the pane to select Inpatient (IP) or Outpatient (OP).
If this is a concurrent review for an existing authorization, enable the Concurrent Review toggle. The system prompts you to enter the existing authorization ID from your EHR system. See the Concurrent Review Workflow section below for the full process.
[Screenshot: The Auth Type toggle showing IP and OP options, with the Concurrent Review toggle below it and the existing authorization ID field visible]
Step 3: Verify the Service Request Type
The Service Request Type is pre-classified by the AI during document processing. The most common classifications are Standard, Expedited, and Concurrent. Verify that the service request type displayed in the authorization summary is correct.
For concurrent reviews, this field is automatically set to "CONCURRENT."
Step 4: Verify the Included Fields
The Authorization Review pane displays a structured summary of the data that will be sent to the EHR. The fields shown are driven by the checkboxes you selected in the Detected Workflow pane -- only checked fields appear in the authorization summary. The pane organizes this data into sections:
Authorization details:
Service request type (pre-classified by the AI as Standard, Expedited, or Concurrent)
Unit type, service type, and bed level (when applicable)
Member information:
Patient name, member ID, date of birth (sourced from the Detected Workflow pane and validated against your EHR)
Provider information:
Requesting provider name and facility name
Date information:
Start and end dates of service (and admit/discharge dates for inpatient cases)
If any field value needs correction, return to the Detected Workflow pane to edit it. When you return to the Authorization Review pane, the updated values are reflected automatically.
[Screenshot: The Authorization Review pane showing authorization details at top, member and provider information in the middle, and date information below, all populated from the Detected Workflow pane checkboxes]
Step 5: Verify Procedures
The procedures section shows all CPT/HCPCS codes that were checked in the Detected Workflow pane. Only procedures you checked there appear in the authorization summary. Each procedure displays:
Procedure description and CPT/HCPCS code
Requested units
The procedures section is collapsible -- click the header to expand or collapse it. If procedures are missing, return to the Detected Workflow pane to check the relevant procedure checkboxes.
Note: For DME documents, the system automatically maps DME-specific fields (such as procedure codes and descriptions) to the standard authorization format. No additional steps are needed.
[Screenshot: The procedures section in the Authorization Review pane showing two checked procedures with CPT codes, descriptions, and unit counts, with the section expanded]
Step 6: Verify Diagnoses
The diagnoses section shows all ICD-10 codes that were checked in the Detected Workflow pane, organized by priority:
Primary diagnosis -- The first diagnosis in the list, representing the principal reason for the requested service.
Secondary diagnoses -- Additional relevant conditions listed below the primary.
Like procedures, only diagnoses checked in the Detected Workflow pane are included. The diagnoses section is collapsible. At minimum, a primary diagnosis is required for authorization submission.
[Screenshot: The diagnoses section showing three ICD-10 codes labeled as Primary Diagnosis and Diagnosis 2 and 3, with the section expanded]
Step 7: Assign a Reviewer
Select a Reviewer from the dropdown. This assigns the authorization to a specific reviewer within AcuityNXT for tracking and accountability purposes.
The reviewer list is fetched from your connected EHR system. The dropdown shows reviewer names, and the selected reviewer's EHR user code is displayed below for confirmation.
Step 8: Review and Submit
Review all sections displayed in the Authorization Review pane. The pane itself serves as the authorization summary -- what you see is exactly what will be transmitted to your EHR system. Confirm that:
Authorization type (Inpatient or Outpatient) is correct, shown as a badge in the header
Member information, provider details, and dates are accurate
The correct procedures and diagnoses are included
A reviewer is assigned
Click Confirm & Send to transmit the authorization to AcuityNXT.
The system confirms successful submission, and the document status updates to reflect that the authorization has been sent.
The pane uses color-coded visual theming to help you identify the authorization context at a glance: standard new authorizations display in green, while concurrent reviews display in orange.
[Screenshot: The Authorization Review pane showing the full authorization summary with the green "Confirm & Send" button at the bottom, alongside a Cancel button]
Important: Review all sections carefully before submitting. Once an authorization is sent to your EHR system, it creates a record in AcuityNXT. Corrections after submission must be made directly in the EHR system. Document any post-submission corrections in the Notes pane for your audit trail.
Turnaround Time Tracking
Lilee tracks turnaround time (TAT) for every authorization from the moment the document is received through the point the authorization is submitted. Regulatory deadlines are enforced automatically:
Urgent / Expedited
72 hours (3 days) from receipt
Warning at fewer than 12 hours remaining
Standard
168 hours (7 days) from receipt
Warning at fewer than 24 hours remaining
TAT indicators appear on the Intake Dashboard in the Turnaround Time column. Each indicator includes a real-time countdown that updates every second:
Gray badge with circular progress
Normal -- sufficient time remaining
Amber badge with circular progress
Warning -- approaching the deadline
Red badge with alert icon
Overdue -- the deadline has passed
The countdown displays hours, minutes, and seconds remaining (for example, "18h 42m 15s"), along with a circular progress indicator showing the percentage of total time that has elapsed. The circular indicator changes color as the deadline approaches: green when ample time remains, amber past the halfway point, and red when time is critically low or expired.
[Screenshot: The TAT indicator on the Intake Dashboard showing an amber warning state with 8 hours remaining, a circular progress indicator, and a live countdown]
Compliance Checkpoint: CMS requires that standard prior authorization determinations be completed within the applicable regulatory timeframe, and expedited requests within 72 hours. Lilee displays these deadlines prominently to help you maintain compliance. If a case is approaching its deadline, prioritize it in your workflow or escalate to your supervisor immediately.
Concurrent Review Workflow
Concurrent review is used when a member is currently receiving services under an existing authorization and additional review is needed to determine continued medical necessity.
When to Use Concurrent Review
An inpatient member's authorized bed days are approaching expiration and the care team is requesting an extension.
New clinical information has arrived for a member with an active authorization that changes the clinical picture.
A scheduled review interval has been reached for an ongoing treatment.
Steps for Concurrent Review
Open the document associated with the concurrent review request from the Intake Dashboard.
In the Authorization Review pane, enable the Concurrent Review toggle.
Enter the existing authorization ID from your EHR system. This links the new submission to the original authorization rather than creating a duplicate record.
The pane switches to orange-themed styling to visually distinguish concurrent reviews from standard new authorizations. The linked authorization ID is displayed prominently at the top of the pane.
The service request type automatically sets to "CONCURRENT."
Verify the updated procedures, diagnoses, and service dates that reflect the extension or continuation request.
Complete the clinical review for the updated request, evaluating continued medical necessity against the applicable coverage policy.
Assign a reviewer.
Click Confirm & Send to submit the concurrent review update.
[Screenshot: The Authorization Review pane in orange concurrent review mode, with the linked authorization ID displayed at the top, orange-themed cards, and the orange "Confirm & Send" button at the bottom]
Tip: Before submitting a concurrent review, open the History pane from the toolbar to review the complete document timeline for the current patient. This shows all prior documents, including the original authorization and any previous concurrent reviews, giving you the full context for your medical necessity evaluation.
Status Transitions and History Tracking
Document Status Workflow
Documents in Lilee move through two primary states:
In Review -- The document is in your inbox, awaiting clinical review and authorization processing.
Processed -- The authorization has been submitted to the EHR system, or the document has been fully reviewed and completed.
When you successfully submit an authorization via the Send to EHR action, the document transitions from In Review to Processed automatically.
Patient Document Timeline
The History pane provides a chronological timeline of all documents associated with the current patient:
Click the History toggle in the toolbar to open the patient timeline.
Each document is displayed as a card showing the document type, date, AI-generated summary, and healthcare tags.
Click any card to navigate to that document and view its full details.
The timeline shows authorization state information, indicating which documents have been submitted to the EHR and which are still pending.
Use the Concurrent Review toggle on any document card to mark it for the concurrent review workflow.
[Screenshot: The History pane showing a patient timeline with four documents -- an initial prior authorization (processed), supporting medical records (processed), a concurrent review request (in review), and recent clinical notes (in review)]
This timeline view is valuable for understanding the full authorization history before making a new submission, especially for concurrent reviews and complex cases with multiple rounds of documentation.
Creating a Manual Authorization
In addition to processing incoming documents, you can create an authorization from scratch when no incoming document is available (for example, when processing a phone request or creating a proactive authorization):
Click the New dropdown in the dashboard toolbar and select the document type for the authorization. This option is available to payer organizations only.
Enter member information, provider details, procedure codes (CPT/HCPCS), diagnosis codes (ICD-10), and service dates manually.
Set the authorization type (IP or OP), service request type, and urgency level.
Complete clinical review for the manually created authorization.
Submit to the EHR following the standard authorization review workflow.
[Screenshot: The Create Authorization button in the dashboard toolbar, with the manual entry form showing empty fields for member, provider, and service details]
Provider Communication
After an authorization determination is made, Lilee supports several communication methods to close the loop with providers and internal stakeholders:
Nurse review letter: Generate and email a clinical review letter summarizing the determination. The letter is auto-generated from your clinical review results and can be customized before sending. See the Clinical Review guide for the full nurse letter workflow.
Clinical review summary PDF: Send the clinical review summary as a PDF attachment via the Send CR Summary action in the Clinical Review pane. This provides a formal record of the clinical criteria evaluation and recommendation.
Internal notes: Use the Notes pane to document internal communications about the case. Notes support four types:
General
General observations and comments
Clinical
Clinical findings, observations, and reviewer notes
Administrative
Administrative actions, routing decisions, and process notes
Follow-up
Items requiring follow-up action
Notes are attributed to the authoring user with a timestamp and appear in chronological order. The Notes pane auto-refreshes every 30 seconds, so team members can collaborate in near-real-time.
[Screenshot: The Notes pane showing a clinical note from a reviewer documenting the clinical rationale, an administrative note about the EHR submission, and a follow-up note about a pending provider callback]
Tip: Use the Notes pane to document provider callbacks, peer-to-peer (P2P) discussion summaries, and any additional context that supports the authorization determination. These notes become part of the permanent case record and are available for audit review.
Tips and Best Practices
Accuracy: Always verify the authorization preview before submitting. Confirm that procedure codes, diagnosis codes, member information, and dates are correct. Errors in the EHR submission require manual correction in AcuityNXT.
Efficiency: If you process authorizations for similar service types regularly, establish a consistent review pattern: verify member, verify provider, check procedures and diagnoses, confirm dates, review preview, then submit.
Concurrent reviews: When processing a concurrent review, always check the History pane first to understand the full authorization timeline. This context helps you assess continued medical necessity accurately.
Compliance: Monitor your TAT indicators throughout the day. Sort the Intake Dashboard by turnaround time to surface cases closest to their deadlines.
Validation: Pay attention to the member and provider validation indicators in the Detected Workflow pane. Green checkmarks mean the data matches your EHR records. Flags or warnings mean manual verification is needed before submission.
Documentation: Use the Notes pane to record your reasoning, especially for complex cases, concurrent reviews, and any case where you overrode the AI recommendation during clinical review.
Compliance Notes
Regulatory Requirement: CMS requires that standard prior authorization determinations be completed within the applicable regulatory timeframe. Expedited requests must be completed within 72 hours. Lilee tracks these deadlines automatically and provides visual indicators when deadlines are approaching or have passed.
Audit Trail: All authorization submissions are logged with the submitting user, timestamp, complete authorization data sent, and the EHR system response. Overrides, edits, and resubmissions are captured as separate audit entries.
HIPAA: Authorization data is transmitted to AcuityNXT over a secure connection. Do not export or download authorization data to unsecured devices. Access authorization records only for members within your authorized scope.
Regulatory Timelines: The system displays warning indicators when a case approaches its TAT deadline. Overdue cases should be escalated immediately to your supervisor per your organization's escalation protocol.
Documentation Standards: Every authorization submission must include at minimum: a valid member ID, at least one procedure code (CPT/HCPCS), a primary diagnosis code (ICD-10), and requesting provider information. The system enforces these requirements before allowing submission.
Troubleshooting
The Authorization Review pane is not available
Your organization may be configured as a provider, or you may lack authorization submission permissions
Contact your administrator to verify your organization type and role permissions
The Confirm & Send button is disabled
Required fields may be missing (member ID, procedure code, diagnosis code, or provider information) or the submission is in progress
Review the authorization summary and verify all required fields are present. Ensure at least one procedure and one diagnosis are checked in the Detected Workflow pane
The authorization submission failed
The EHR system may be unavailable, or the member/provider data may not match EHR records
Check the error message for details. Verify member and provider validation in the Detected Workflow pane. Correct any mismatches and retry the submission
Service request types are not loading in the dropdown
The EHR integration may be temporarily unavailable
Refresh the page and try again. If the issue persists, contact your administrator to verify the EHR connection status
I need to correct a submitted authorization
Corrections cannot be made in Lilee after submission
Make the correction directly in AcuityNXT. Document the correction and reason in the Notes pane for your audit trail
The concurrent review toggle does not appear
The document may not be classified as a type that supports concurrent review
Verify the document type. Concurrent review is available for prior authorization and concurrent review document types
Related Features
Intake Dashboard -- Receive, triage, and verify incoming documents before proceeding to authorization review.
Clinical Review -- Evaluate medical necessity against Medicare coverage policies before submitting the authorization.
Ellie AI Assistant -- Use Ellie's Suggest Next Steps, Validate Codes, and Benefits Check quick actions to prepare for authorization submission.
Last updated: February 24, 2026 | Version: 1.0
Last updated
Was this helpful?