Where it sits in the journey
Starts from the referral. Hands off to case management.
The clinical picture comes from admissions and the rules come from the payer contract. Once approved, the authorization and its dates carry into case management.
What it does
Built from the packetDiagnoses, skilled needs and therapy status come from the referral, each with its source.
Documents attachedThe clinical documents the payer needs are attached to the request.
Submitted and followedSent through payer portals and checked until there is a decision.
Contract rules appliedYour contract sets when authorization is required and what comes next.
The request
The request fills itself in from the referral
Nobody retypes the discharge summary. Diagnoses, skilled needs, wound care and therapy status are carried over from admissions, and each field shows the document and page behind it.
Authorization requestPre-filled from referral
DiagnosisOsteomyelitis, left footH&P · p. 3
Skilled needIV vancomycin every 12 hours, 14 daysDischarge summary · p. 37
Wound careStage 3 sacral injury · wound VACWound note · p. 112
TherapyPT and OT evaluations completedPT evaluation · p. 88
Prior functionIndependent with rolling walkerPT evaluation · p. 91
2026 Medicare Advantage agreementContract rules
WhenBefore admissionp. 9Applied
DocumentsH&P, therapy evaluations, medication listp. 10Attached
Wound VACSeparate approval beyond 14 daysp. 14Flagged
Next stepConcurrent review every 7 daysp. 11Scheduled
Discharge summaryHistory & physicalPT and OT evaluationsMedication list
Contract rules
Your contract decides what the payer needs
MedFlo reads the payer agreement in your contract library: whether authorization is required, which documents to send, which services need separate approval and when the first review is due.
Follow-through
Followed until there is an answer
Submitted requests are checked until the payer decides. The MedFlo agent can call the payer with an AI phone agent and write the answer back. Approvals move straight into case management with their dates.
Request historyR. Morales, 78
Sep 12Submitted through payer portalDone
Sep 12Status checked · pendingPending
Sep 13Payer asked for therapy notes · attachedDone
Sep 13Called payer · status written backDone
Sep 13Approved through Sep 19Approved
NextHanded to case managementReview Sep 18
Connected in the journey