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The PA workflow runs through 17 documented states with payer-specific rules and 5-channel submission. Voice agent The PA Specialist handles outbound peer-to-peer calls.

State machine

medera/pa-workflow.svg17-state PA workflowPrior authorization · 17-state workflowPA_INITIATEDCRITERIA_EVALUATIONCRITERIA_EVALUATEDDOCUMENTS_READYSUBMITTEDIN_REVIEWPENDEDINFO_REQUESTEDAPPROVEDOn denialDENIEDAPPEALP2POVERTURNEDEXPIREDWITHDRAWNCLOSEDARCHIVEDSubmission channelsEPA_APICLEARINGHOUSEPORTALFAXMANUALSame state machine across every channel · per-payer rules · evidence-anchored
1

Evaluate criteria

2

Create the PA request

Initial state: PA_INITIATED.
3

Generate documents

4

Submit

Submission selects the highest-priority available channel:
5

Track and appeal

Poll status; if denied, generate the appeal with new evidence.

Supported payers

CARELON_ANTHEM, OPTUM_BH, MAGELLAN, EVERNORTH, UNITED_HEALTHCARE, AETNA, CIGNA, BLUE_CROSS, MEDICAID, MEDICARE.

Document types

MEDICAL_NECESSITY, CLINICAL_SUMMARY, TREATMENT_PLAN, ASSESSMENT, PROGRESS_NOTE, DISCHARGE_SUMMARY — plus X-12 EDI 278 for clearinghouse submission.

What’s next

Prior Authorization Agent

Agent-level documentation.

PA API

Full REST surface.

Denial Appeals

Appeal lifecycle.

Eligibility

Pre-visit benefits.