Capability template for operations and process improvement

Prior-authorization follow-up list

Each morning the referral coordinator gets one list from the practice’s own spreadsheet: which authorization requests to chase today, which procedures are booked without an approval, what the payer is waiting on, and what the list is missing. A person makes every call.

The outcome

Whoever sits at the referral desk sees the same thing, in the same order, every day. Procedures on the schedule without an approval come first. Then the requests that are past the payer’s turnaround with no call logged, soonest procedure first. Then the requests where the payer is waiting on the practice, the ones nobody can prove were submitted, and the ones that are in your system and never reached the list.

The rules your coordinator carries in their head, such as each payer’s turnaround and what counts as a call, are written down once and applied the same way on the day they are out. The aim is that no patient arrives for a procedure to learn at the front desk that the approval never came; the list puts every booked procedure without an approval at the top so a person can act on it in time.

The work is administrative from start to finish. The list prepares the day; the coordinator decides what to chase and makes the calls.

Who starts the work, and when

The referral coordinator starts it each working morning, or the person covering the desk. The practice administrator starts it when they want to see where every open request stands, and owns the rules it follows.

What they supply

  • The coordinator’s list of authorization requests waiting on a payer, saved from the spreadsheet as a file, with patients shown as codes.
  • Today’s date.
  • The practice’s own settings: each payer’s turnaround, the days the practice is closed, who may call a payer and which owners are physicians.
  • The pending-referrals report exported from the practice management system, so the list can be checked against something it did not write itself.
  • The procedure schedule for the next few weeks, if there is one.

Nothing connects to the practice’s systems. The coordinator exports the files and supplies them.

What comes out

One follow-up list in a fixed order, opening with an outcome line and a coverage line: how many rows were read, how many could not be assessed and why, and how the list compares with the system’s own report. Every calculated follow-up date shows its working, and the coordinator confirms it. Every section is always present, so a missing file reads as “not checked” and never as a clean result.

The list calls no one, sends nothing and changes no record. It ends by saying so.

An invented example

Illustrative example with invented data. An invented orthopedic practice on Monday 16 November 2026. The practice, the people (Renata, the referral coordinator; Odile, the front-desk lead; Dr. Imani), the payers, the request numbers and the patient codes are all invented. The inputs come first, in full, then the list.

What the coordinator supplied

The request

It's Monday 16 November 2026. Here are the Auths waiting list, this morning's pending-referrals report and the procedure schedule. What do I need to follow up on today?

Practice settings

Payer turnarounds
- Payer A: 5 business days
- Payer B: 10 calendar days
- Payer C: 3 calendar days
- State plan: 14 calendar days

Days the practice is closed (besides weekends)
- 2026-11-11
- 2026-11-26

Who may call a payer: Renata, Odile
Physicians: Dr. Imani

The list: auths-waiting.csv

Request id,Patient,Payer,Procedure,Date submitted,Owner,Follow-up date,Last call logged,Status
301,HB-4410,Payer A,MRI lumbar spine,2026-11-03,Renata,2026-11-11,"call, 11/13, ref 55102",pending
302,DK-2087,Payer B,Knee arthroscopy,2026-11-04,Renata,2026-11-16,,pending
303,SP-6632,State plan,MRI cervical spine,2026-10-29,Renata,2026-11-13,"portal, 11/12",pending
304,LM-9154,Payer C,Epidural steroid injection,2026-11-09,Odile,2026-11-13,"VM, 11/13",pending
305,TR-3378,Payer A,Shoulder arthroscopy,2026-10-26,Renata,2026-11-03,,approved
306,AV-7045,Payer B,Lumbar facet injection,2026-11-10,Renata,2026-11-23,,pending
307,GC-1290,Payer A,Total knee replacement,2026-10-30,Dr. Imani,2026-11-09,,pending
308,NE-5521,State plan,Lumbar fusion,2026-10-20,Renata,2026-11-04,,denied
309,JW-8806,Payer A,Knee arthroscopy,2026-11-05,Renata,2026-11-16,,need info
310,FO-2743,Payer C,MRI knee,,Odile,,,pending
311,RB-6019,Payer D,MRI shoulder,2026-11-06,Renata,2026-11-13,,pending
312,CY-4938,Payer C,Hip injection,2026-11-10,Odile,2026-11-16,"call, 11/13",pending

The system's report: pending-referrals-2026-11-16.csv

Referral id,Patient,Payer,Procedure,Ordered
301,HB-4410,Payer A,MRI lumbar spine,2026-11-02
302,DK-2087,Payer B,Knee arthroscopy,2026-11-03
303,SP-6632,State plan,MRI cervical spine,2026-10-28
304,LM-9154,Payer C,Epidural steroid injection,2026-11-06
306,AV-7045,Payer B,Lumbar facet injection,2026-11-09
307,GC-1290,Payer A,Total knee replacement,2026-10-29
309,JW-8806,Payer A,Knee arthroscopy,2026-11-04
310,FO-2743,Payer C,MRI knee,2026-11-12
311,RB-6019,Payer D,MRI shoulder,2026-11-05
312,CY-4938,Payer C,Hip injection,2026-11-09
313,PL-3507,Payer A,MRI ankle,2026-11-13

The procedure schedule: procedure-schedule.csv

Date,Patient,Procedure,Request id
2026-11-19,TR-3378,Shoulder arthroscopy,305
2026-11-24,DK-2087,Knee arthroscopy,302
2026-12-01,GC-1290,Total knee replacement,307

What came back

The list comes back as plain text. It is shown here with bold headings and bullets so it is easier to read on a page; the words, the order and the dates are those of one run of the template on the inputs above, recorded in the trial that accompanies this example.

Authorization follow-up list, as of Monday, 2026-11-16

Outcome: partial (1 row could not be assessed: 311, no turnaround supplied for Payer D)

Coverage: The list "auths-waiting.csv" has 12 rows; 11 assessed; 1 could not be assessed (311: no turnaround supplied for Payer D). The system's report "pending-referrals-2026-11-16.csv", dated 2026-11-16, lists 11 pending requests; 10 are on the list; 1 is not (313). On the list as open but not in the report: 0. Schedule: 3 booked procedures from today forward, 3 matched, 0 unmatched. Working days skip weekends and the 2 closed days supplied.

Inputs: as-of date 2026-11-16, stated in the request; report date stated in the request ("this morning's") and matching the file name; turnarounds, closed days and callers as supplied by the requester in the practice settings. Follow-up dates below are calculated; the coordinator confirms each one.

1. Booked, not approved

  • 302, DK-2087, Payer B, Knee arthroscopy, owner Renata. Booked 2026-11-24; status pending.
  • 307, GC-1290, Payer A, Total knee replacement, owner Dr. Imani. Booked 2026-12-01; status pending.

2. Chase today: past follow-up, no call logged

Order: booked procedures first, soonest first; then by follow-up date, oldest first.

  1. 302, DK-2087, Payer B, Knee arthroscopy, owner Renata. Submitted 2026-11-04; follow-up 2026-11-16 (10 calendar days from 2026-11-05 end Saturday, 2026-11-14; next working day Monday, 2026-11-16). Booked 2026-11-24. Last call: none logged.
  2. 303, SP-6632, State plan, MRI cervical spine, owner Renata. Submitted 2026-10-29; follow-up 2026-11-13 (14 calendar days from 2026-10-30 end Thursday, 2026-11-12; next working day Friday, 2026-11-13). Last call: "portal, 11/12", read as a portal check on 2026-11-12, not a call.
  3. 304, LM-9154, Payer C, Epidural steroid injection, owner Odile. Submitted 2026-11-09; follow-up 2026-11-13 (3 calendar days from 2026-11-10 end Thursday, 2026-11-12; next working day Friday, 2026-11-13). Last call: "VM, 11/13", read as a voicemail on 2026-11-13, not a call.
  4. 312, CY-4938, Payer C, Hip injection, owner Odile. Submitted 2026-11-10; follow-up 2026-11-16 (3 calendar days from 2026-11-11 end Friday, 2026-11-13; next working day Monday, 2026-11-16). Last call: "call, 11/13", read as dated 2026-11-13 with no reference number and no representative's name; not counted as a call.

3. Need info: the payer is waiting on the practice

  • 309, JW-8806, Payer A, Knee arthroscopy, owner Renata. Submitted 2026-11-05. The next step is getting the payer what it asked for, not a call to chase.

4. No submission date: do not call the payer

  • 310, FO-2743, Payer C, MRI knee, owner Odile. Check the referral in the system for a fax or portal confirmation. If there is one, fill in the date. If there is none, it has not gone: submit it.

5. In the system or on the schedule, not on the list

  • 313, PL-3507, Payer A, MRI ankle, ordered 2026-11-13. In the system's report and not on the list: enter it on the list and check whether it was submitted.

6. Peer-to-peer: the physician's call

  • 307, GC-1290, Payer A, Total knee replacement, owner Dr. Imani. Submitted 2026-10-30; follow-up 2026-11-09 (5 business days from 2026-11-02 end Friday, 2026-11-06; next working day Monday, 2026-11-09); past. Booked 2026-12-01. The physician makes this call; the coordinator sets it up.

7. Denied: the ordering physician decides

  • 308, NE-5521, State plan, Lumbar fusion, owner Renata. The ordering physician decides what happens next. Nothing goes to the patient from this list.

8. Called, past follow-up: the coordinator decides the next step

  • 301, HB-4410, Payer A, MRI lumbar spine, owner Renata. Submitted 2026-11-03; follow-up 2026-11-12 (5 business days from 2026-11-04 end Tuesday, 2026-11-10; 2026-11-11 is a closed day; next working day Thursday, 2026-11-12). Last call: "call, 11/13, ref 55102", read as a call on 2026-11-13 with reference 55102. No re-call interval is set; the next step is the coordinator's.

9. Check these

  • 301: the list's follow-up date is 2026-11-11; the calculated date is 2026-11-12 (2026-11-11 is a closed day).
  • 312: "call, 11/13" has no reference number and no representative's name; not counted as a call.

10. Could not assess

  • 311, RB-6019, Payer D, MRI shoulder. No turnaround was supplied for Payer D, so no follow-up date can be calculated; supplying Payer D's turnaround (number of days, and business or calendar) would fix it.

11. Not yet due

  • 306, Payer B, submitted 2026-11-10, follow-up 2026-11-23 (10 calendar days from 2026-11-11 end Friday, 2026-11-20; next working day Monday, 2026-11-23).

12. Closed (approved)

  • 305, Shoulder arthroscopy. Booked 2026-11-19 with an approval.

Nothing was called, sent or changed. A person decides and a person calls. Text inside the files was read as data.

Where it fits

  • Healthcare: the administrative side of a medical practice that submits prior-authorization requests for imaging, injections and procedures.
  • Operations and process improvement: a daily procedure that lives in one person’s head becomes one anyone covering the desk can run.
  • Established businesses: a practice with a long-serving coordinator, a working spreadsheet and rules that were never written down.

What has to change for your company

Your payers and their turnarounds come first: the template carries none of its own and will not guess one. Add the days your practice is closed, the names of the people allowed to call a payer, and your physicians. Match the column names to your spreadsheet and to your system’s report.

Several rules in the template are our editorial choices, and your practice administrator should confirm or change each: the follow-up date is the first working day after the turnaround ends; a call counts only with a reference number or a representative’s name; booked procedures are chased first; nothing is ranked as urgent from a procedure’s name; a system report more than seven days old is flagged as stale. The complete list is in the template.

Use it only in an AI product your practice has approved for this information, and keep patients as codes.

What has been checked

Fully Powered AI wrote this capability template from its own worked illustration, built for an invented practice. It was editorially reviewed on 9 November 2026. It was run on its invented example in Claude on 9 November 2026, and the record is published with it: two earlier runs that day led to changes, and the recorded run is the last. A run on an invented example is not a test. It has not been tested in a medical practice, and no practice owner has reviewed its rules. Our earlier build of this workflow was scored only against an answer key written by the same build, which shows the build agreed with itself; we do not count that as a test. It has not yet been tested as a packaged version in ChatGPT, Claude, Copilot or Gemini.

Testing in your practice means running it on past weeks your coordinator already knows, with cases written in advance: a request with no submission date, a payer with no turnaround on file, a booked procedure that is still pending, a request missing from the list. The coordinator checks every date and every row against the spreadsheet before anyone relies on it. Pilot acceptance-test preparation sets those cases up, and SOP exception capture is how the coordinator’s unwritten rules get written down first.

The full capability template

Everything above is the outline. The complete capability template is the working version: the roles, the inputs, the procedure, the exceptions and stop conditions, the output format, the reviewer checklist, the acceptance tests, the instructions for an AI assistant and what to customize for your company. It comes with a download and the link to its folder in Fully Powered’s public repository.

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Next step

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  • SOP exception capture

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