How hospitals hand off referrals, prior authorizations and discharge planning to the back office

In most hospitals the referral, the prior authorization, the consent and the post-acute packet still move by fax, phone and email, and the back office learns about the work days after the clock started. Callvu runs the handoff end to end: it prefills from the EHR, classifies the request, chases the specialist, the payer or the facility on the deadline, routes each decision to the right person in the Decision Desk and writes the result back to the EHR.

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The problem today

The front door got faster.The back office did not.

Today, without Callvu

Medication prior authorization

The patient left the pharmacy without the medication, and the prior authorization form was still on the printer in the clinic.

Today, without Callvu

Research informed consent

The monitor found participants consented on a version the IRB had retired three weeks earlier, and the sponsor stopped enrollment.

Today, without Callvu

Scheduled-procedure prior authorization

The authorization request went to the payer with the wrong code and no imaging, and the denial arrived two days before the surgery.

How Callvu runs it

Twelve healthcare processes,from the request to the system of record.

Twelve healthcare handoffs run end to end: prefill, classify, chase and verify, decide, write back. Each page names the parties, the front door, what the back office receives and the decisions that go to the Decision Desk.

Complex: multi-party handoffs

Medication prior authorization

Starts when a prescription needs approval; clinical criteria and history gathered, submitted, and the result returned to the prescriber and patient.

Parties: Prescriber and clinic staff, Payer or pharmacy benefit manager, Patient, Pharmacy

Complex: multi-party handoffs

Research informed consent

Starts when a patient is approached for a study; the approved consent version is presented, questions logged, signatures and witness captured, and the record sent to the research office.

Parties: Participant or legally authorized representative, Study team member obtaining consent, Witness and interpreter, Research office and IRB

Complex: multi-party handoffs

Scheduled-procedure prior authorization

Starts from the EHR order; the payer's required documents checked before sending, gaps chased on the procedure-date clock, and the decision written to the EHR.

Parties: Ordering clinician, Authorization team, Payer, Patient

Complex: multi-party handoffs

Surgical informed consent, chained with anesthesia consent

Starts after the consult; identity checked, consent explained and signed on a controlled screen ahead of the day, and the signed record filed to the EHR.

Parties: Patient or legal representative, Surgeon and anesthesia practitioner, Witness and interpreter

Complex: multi-party handoffs

Good faith estimates

Starts from the booking of an uninsured or self-pay service; the estimate is built and delivered on the No Surprises Act clock, with delivery recorded.

Parties: Patient, Scheduling and financial counseling, Co-providers

Complex: multi-party handoffs

Outbound referral to a specialist

Starts from the ordering provider; clinical notes and coverage packaged, sent to the specialist and tracked until the appointment is booked.

Parties: Ordering provider and office, Patient, Specialist office, Referral coordinator

Complex: multi-party handoffs

Discharge planning and post-acute placement

Starts when discharge is planned; patient choice, clinical packet and authorization sent to post-acute facilities, acceptances tracked until placement.

Parties: Patient or representative, Case manager or discharge planner, Post-acute facilities and agencies, Payer

Complex: multi-party handoffs

Contract and agency staff onboarding

Starts when agency staff are booked; credentials, competencies and access requests collected before the first shift.

Parties: Agency, Worker, Staffing office, Department manager

Complex: multi-party handoffs

Home health and hospice referrals

Starts from the discharging provider; orders, face-to-face documentation and coverage packaged and sent to the agency, acceptance tracked.

Parties: Certifying physician, Patient or caregiver, Agency, Case manager

Complex: multi-party handoffs

Claim denial appeals

Starts when a claim denies; the denial is classified, supporting records and a letter assembled, and the appeal filed within the payer's deadline.

Parties: Denials specialist, Physician advisor and the treating physician, Health information management and coding, Payer

Complex: multi-party handoffs

Payer document requests

Starts when a payer asks for more records; the request is matched to the case, documents pulled and checked, and the response sent on the payer's clock.

Parties: Payer, Health information management and clinical departments, Revenue integrity or health information team

Complex: multi-party handoffs

Pre-surgery intake

Starts from the booking; prefilled from the EHR, the procedure type sets the questions and documents, and the completed file returns to the EHR.

Parties: Patient or guardian, Outside providers, Pre-admission nurse, anesthesia and the surgical team

See all 83 healthcare processes

The rules and the clocks

The rules and clocksthe handoff runs under.

Every handoff runs against the regulation and the deadlines that apply to it. Each rule and each clock links to the process pages where it is enforced.

Regulations

HIPAA

HIPAA Privacy Rule (45 CFR 164.506) and the patient notice requirementsMedication prior authorization
HIPAA research authorization (45 CFR 164.508 and 164.512(i))Research informed consent
HIPAA transaction standards (the X12 278 referral and authorization transaction) and the Privacy RuleScheduled-procedure prior authorization
HIPAA Privacy and Security Rules (45 CFR 164.312 and 164.530)Surgical informed consent, chained with anesthesia consent
HIPAA Privacy Rule, disclosures for treatment (45 CFR 164.506) and the transmission security standards (45 CFR 164.312(e))Outbound referral to a specialist
HIPAA Privacy Rule disclosures for treatment and the discharge summary (45 CFR 164.506)Discharge planning and post-acute placement
HIPAA Privacy Rule disclosures for treatment (45 CFR 164.506)Home health and hospice referrals
HIPAA Privacy Rule (45 CFR 164.506 and 164.502(b))Payer document requests
HIPAA Privacy and Security Rules (45 CFR 164.502, 164.508 and 164.312)Pre-surgery intake

CMS

CMS prior authorization rule (the Interoperability and Prior Authorization final rule, CMS-0057-F)Scheduled-procedure prior authorization
CMS discharge planning conditions of participation (42 CFR 482.43) and the IMPACT Act requirementsDischarge planning and post-acute placement
CMS Conditions of Participation on personnel and nursing services (42 CFR 482.11(c), 482.23(b)(6) and 482.42)Contract and agency staff onboarding
CMS discharge planning conditions of participation (42 CFR 482.43)Home health and hospice referrals

Anesthesia consent and the Universal Protocol

Anesthesia consent and the Universal Protocol (42 CFR 482.52; the ASA standards; the Joint Commission UP.01.01.01 and the pre-procedure verification)Surgical informed consent, chained with anesthesia consent

Common Rule

Common Rule (45 CFR 46)Research informed consent

Electronic prior authorization standards

Electronic prior authorization standards (the NCPDP SCRIPT ePA transactions, the CMS Part D ePA requirement, the CMS Interoperability and Prior Authorization rule for the medical benefit)Medication prior authorization

ERISA

ERISA claims procedures (29 CFR 2560.503-1) and the ACA internal and external review rules (45 CFR 147.136) for member appealsClaim denial appeals

FDA

FDA informed consent regulations (21 CFR 50) and ICH good clinical practice (E6) for regulated studiesResearch informed consent

Federal exclusion screening, state background check laws for health care workers, and the HIPAA workforce rules

Federal exclusion screening (42 CFR 1001.1901), state background check laws for health care workers, and the HIPAA workforce rulesContract and agency staff onboarding

Hospital price transparency and the hospital's self-pay pricing policy

Hospital price transparency (45 CFR 180) and the hospital's self-pay pricing policyGood faith estimates

Informed consent law and the medication reconciliation standard

Informed consent law (state statutes and 42 CFR 482.13(b)(2)) and the medication reconciliation standard (Joint Commission NPSG.03.06.01)Pre-surgery intake

Informed consent requirements

Informed consent requirements (42 CFR 482.13(b)(2), 482.24(c)(4)(v) and 482.51(b)(2); state informed consent statutes; the Joint Commission RI.01.03.01)Surgical informed consent, chained with anesthesia consent

Joint Commission human resources and leadership standards for contract staff

Joint Commission human resources and leadership standards for contract staff (HR.01.02.05, HR.01.02.07, HR.01.06.01 and LD.04.03.09)Contract and agency staff onboarding

Medical necessity criteria, the payer's medical policies and the Medicare coverage determinations

Medical necessity criteria, the payer's medical policies and the Medicare coverage determinationsClaim denial appeals

Medical record authentication and retention

Medical record authentication and retention (42 CFR 482.24, state record laws)Payer document requests

No Surprises Act good faith estimate requirements

No Surprises Act good faith estimate requirements (45 CFR 149.610)Good faith estimates

Patient-provider dispute resolution

Patient-provider dispute resolution (45 CFR 149.620)Good faith estimates

Payer appeal deadlines

Payer appeal deadlinesClaim denial appeals

Payer authorization for post-acute care and the Medicare three-day rule and notices

Payer authorization for post-acute care and the Medicare three-day rule and noticesDischarge planning and post-acute placement

Payer coverage rules

Payer coverage rulesHome health and hospice referrals

Payer documentation and audit rules

Payer documentation and audit rules (the Medicare additional documentation request rules with the 45-day response period, the Medicaid and commercial payer contract terms, the Recovery Audit Contractor rules)Payer document requests

Payer formulary rules

Payer formulary rulesMedication prior authorization

Payer prior authorization rules

Payer prior authorization rulesScheduled-procedure prior authorization

Plan referral and network rules and the HIPAA 278 transaction

Plan referral and network rules and the HIPAA 278 transaction (45 CFR 162)Outbound referral to a specialist

Referral tracking standards and 42 CFR Part 2 where substance use records are involved

Referral tracking standards (the NCQA patient-centered medical home standards and the care coordination quality measures) and 42 CFR Part 2 where substance use records are involvedOutbound referral to a specialist

Surgical and anesthesia standards

Surgical and anesthesia standards (42 CFR 482.51 and 482.52 Conditions of Participation; the ASA pre-anesthesia evaluation standards; the Joint Commission Universal Protocol and PC.01.02.03)Pre-surgery intake

Clocks and deadlines

Payer decision: Medication prior authorization: The plan's period from submission (for example 72 hours standard and 24 hours expedited under Medicare Part D), tracked with escalation.; Scheduled-procedure prior authorization: The payer's timeframe, and under the CMS rule seventy-two hours expedited and seven calendar days standard for the covered payers.
Evidence chase: Medication prior authorization: Reminders to the prescriber on the schedule, with the patient's wait in view.
Approval validity: Medication prior authorization: The period on the approval; the renewal process opens before it expires.
Before any study procedure: Research informed consent: The signed consent must be on file before enrollment and any research procedure.
Version currency: Research informed consent: The IRB's approval dates; a version change triggers the re-consent process.
Procedure date: Scheduled-procedure prior authorization: The real deadline; submission and chases are scheduled against it with the payer's timeframe subtracted.
Authorization validity: Scheduled-procedure prior authorization: The approved dates and units, with the renewal process set before expiry.
Consent before the day: Surgical informed consent, chained with anesthesia consent: From the consult, chased on the surgery-date clock, completed before sedation.

By role

What changesfor each team.

Compliance

The handoff carries its rules with it. The CMS discharge planning condition on patient choice, the Medicare face-to-face requirement on a home health referral, the Common Rule version control on a research consent and the payer's appeal deadline are enforced as the case moves. The Decision Trace shows what was evaluated and why the case went where it went; the Audit Trace shows who decided, what they saw and when, for every physician, payer and agency step.

A home health referral goes out only with the face-to-face encounter inside its window and the signed orders.
A research participant can only be consented on the IRB-approved version in force.
Every physician, payer and agency decision is recorded with the decider and the file they saw.

Operations

The case manager, the authorization team and the pre-admission nurse stop re-keying and chasing. A request becomes a unit of work the moment it lands, with its skill, effort and due date, so the back office sees the week from minute zero. Facilities, specialists and payers are chased in parallel on their clocks, and only the exceptions reach a person in the Decision Desk.

Post-acute facilities receive the packet at once, not one fax at a time.
A prior authorization is scheduled against the procedure date with the payer's timeframe subtracted.
A denial, a peer-to-peer offer or a non-responding specialist goes to one named person with only the allowed choices.

IT

Callvu starts from the EHR order, the remittance or the HR booking and writes the authorization, the acceptance, the consult note and the decision back by API and webhook. The EHR, the billing system and the identity system stay the systems of record. Outside parties, a specialist office, an agency or a facility, work through a link and need no account in your systems.

Runs on the major EHRs, by API and webhook, under a business associate agreement.
The X12 278 and NCPDP SCRIPT electronic prior authorization transactions run from the process.
A new handoff deploys on the integrations you already have, in weeks.

Customer experience

The patient chooses the specialist or the post-acute facility on their phone, sees the status of the authorization and is not asked to carry the referral themselves. The pre-surgery file and the consents are completed at home after booking, so a missing clearance is handled before the day, not in the holding area. Nobody learns in September that the March referral never arrived.

The patient's choice is captured once and drives the packet.
The status of the referral, the authorization and the placement is visible to the patient and the ordering provider.
Agency and contract staff arrive cleared, with access ready for the first shift.

Proof

In production in healthcare.Published results only.

Each result is a published claim, with its code on agents.callvu.com, where its status, source and last verified date are kept.

A national hospital network runs 23 hospitals on Callvu and keeps adding more, with 3x faster procedure approvals, 78% faster patient consent and more than 1M pages of paper eliminated.

HLT-01 · Self-asserted · verified 2026-11-05

At a national hospital network, a new process deploys in about 2 weeks without a new integration, with 3+ fewer touches per process.

HLT-06 · Self-asserted · verified 2026-11-05

At a national hospital network, a process chains up to five patient forms and signatures and ten internal steps; completing one step starts the next, for example surgery consent starts anesthesia consent and sends the procedure to the approving committee.

HLT-02 · Customer-attested · verified 2026-11-05

Questions

What healthcare buyers ask,answered plainly.

How do hospitals get prior authorizations approved before the procedure date?

Callvu builds the request from the EHR order, checks the payer's required documents before it is sent, and chases the missing note or imaging from the clinic or the outside provider on the procedure-date clock with the payer's timeframe subtracted. Under the CMS Interoperability and Prior Authorization rule the covered payers decide within 72 hours expedited and seven calendar days standard. The decision is written back to the EHR, and a denial goes to the ordering clinician in the Decision Desk.

How Callvu runs it: Scheduled-procedure prior authorization

How do hospitals send home health and hospice referrals so agencies admit without a second round of faxes?

The referral is packaged from the EHR with the signed orders, the certification, the coverage and the face-to-face documentation, and Callvu checks the encounter date against the Medicare window of ninety days before or thirty days after the start of care before anything goes out. A note that falls short goes back to the physician with the specifics. The agency answers through its link, the start of care is written to the EHR, and a decline goes to the case manager in the Decision Desk with the patient's next choice.

How Callvu runs it: Home health and hospice referrals

How do hospitals run post-acute placement without faxing facilities one at a time?

The patient's choice is captured on their phone or a bedside screen as the discharge planning condition of participation (42 CFR 482.43) requires, and the clinical packet and the authorization go to every chosen facility in parallel through their links. The case manager sees each answer and the payer's authorization on one case against the expected discharge date and decides only the exceptions.

How Callvu runs it: Discharge planning and post-acute placement

How do primary care practices track outbound referrals until the consult note comes back?

The referral is packaged from the EHR order with the notes and the coverage, the patient confirms the specialist on their phone, and the specialist acknowledges through its link. Callvu chases the acknowledgment, the appointment and the consult note on the practice's schedule, and the open loop stays visible to the ordering provider in the EHR until it closes.

How Callvu runs it: Outbound referral to a specialist

How do we file claim denial appeals inside the payer's deadline?

The deadline is computed from the payer's rules and the denial date and shown as days remaining. Callvu classifies the denial from the remittance, chases the records, the physician statement and the coding review through their links, and routes the assembled appeal to the denials specialist or the physician advisor with only file, peer-to-peer first, correct and rebill, or accept. The filing and the payer's response are tracked from the decision.

How Callvu runs it: Claim denial appeals

How do clinics get medication prior authorizations approved without the prescriber redoing the chart?

Callvu prefills the patient, the coverage, the medication, the diagnosis, the history with the alternatives tried and the relevant labs from the EHR, mapped to the payer's criteria for the drug. The prescriber supplies through a link only the evidence a specific criterion lacks and decides denials and peer reviews in the Decision Desk. The payer's period, for example 72 hours standard and 24 hours expedited under Medicare Part D, is tracked with escalation, and the pharmacy is told the approval so the medication is dispensed.

How Callvu runs it: Medication prior authorization

Every step of the healthcare handoff is enforced at runtime

Six AI agent evaluators check each step against the regulation and your own policies before it runs.

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Bring your messiest handoff

We build it against your policies and the healthcare systems you already run, train your team and stay with you through launch. You are live in weeks.

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