SecureHealth Utilization Management
Quick Reference
Prior Authorization Documentation Quality Checklist
Before finalizing your authorization, verify that each item below has been completed.
- Member name and ID verified
- Provider information documented
- Request type selected correctly
- Service/procedure documented
- Diagnosis code(s) included
- Request received date/time recorded
2. Eligibility & Benefits
- Eligibility verified
- Benefit plan reviewed
- Authorization requirement confirmed
- Coverage limitations documented (if applicable)
- Correct clinical guideline used
- Guideline version documented
- Clinical information reviewed
- Medical necessity documented
- Decision rationale clearly stated
- Additional information requests documented (if applicable)
- Provider communication documented
- Member communication documented
- Dates and communication methods recorded
- Decision status accurate
- Effective dates verified
- Reviewer identified
- Authorization number recorded (if applicable)
- Required notifications initiated
Avoid These Common Errors
- Missing clinical rationale
- Wrong clinical guideline referenced
- Missing provider notification
- Incorrect authorization status
- Missing dates or timestamps
- Required attachments not uploaded
- Case closed before documentation was complete
- Document while reviewing—not afterward.
- Use approved terminology and abbreviations.
- Reference the specific clinical guideline used.
- Verify all required fields before submitting.
- Review documentation one final time before closing the case.
Before You Submit — Final Quality Check
Ask yourself:
- Could another reviewer understand this case using my documentation alone?
- Is the clinical rationale clear and supported?
- Have I documented every required communication?
- Would this documentation pass a quality audit?