Scheduled-procedure pre-authorization

How do we pre-authorize a scheduled procedure with the clinical documents and the policy checks completed before the procedure date, and the approval or denial written to the health plan system?

Run the authorization backwards from the procedure date. When a procedure is scheduled, Callvu classifies it (the procedure code, the setting, the provider, whether the plan requires prior authorization, the clinical criteria that apply, the member's eligibility and benefits), requests the clinical documents the criteria need from the provider through their link (the referral, the clinical notes, the imaging and lab results, the conservative treatment history), chases them on a clock set from the procedure date and the plan's decision periods, checks each document against the criteria, routes the decision to the medical reviewer in the Decision Desk with the criteria and the documents, and writes the approval with its validity or the denial with the reasons and the appeal rights to the health plan system, with the provider and the member told before the date. Live at Ministry of Health, under national rules outside the US.

Live at Ministry of HealthComplex: multi-party handoffsCallvu moves: chase and verify, decide, write back

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Last updated November 7, 2026.

The problem today

The procedure was cancelled on the morning because the authorization was pending on a clinical note nobody had asked for.

Today, without Callvu

A procedure is scheduled for a date. The provider submits an authorization request with whatever documents the office has; the plan's reviewer finds the clinical criteria need a note on conservative treatment and sends a request; the office receives it days later; the authorization is still pending on the procedure's eve. The patient is sent home, the operating room slot is lost, and the complaint and the appeal follow.

Prior authorization is governed by the payer's rules: which procedures require it, the clinical criteria (the plan's medical policy, or the recognized criteria sets), the documents that evidence them, the decision periods for standard and urgent requests, the notice contents, the peer review and the appeal rights, and the validity period of an approval. The procedure date is the real deadline, and the documents are the critical path.

An authorization that starts by listing exactly what the criteria need, and chases it from the provider against the date, is decided before the morning.

How it runs

From the requestto the system of record.

A provider schedules a procedure that requires authorization and submits the request, or the scheduling system notifies the plan. Callvu opens the authorization with the procedure date.

Provider: Submits the request and the clinical documents through their link, and receives the decision.
Member: Is told the status and the decision, and their rights.
Medical reviewer: Decides the authorization in the Decision Desk with the criteria and the documents.
Callvu: Classifies, lists the documents the criteria need, chases on the clock, checks, routes and writes.

Classify the request
The procedure code, the diagnosis, the setting, the provider's network status, the member's eligibility and benefits, whether the plan requires prior authorization for this procedure, the clinical criteria that apply (the plan's medical policy or the recognized criteria set), the urgency (standard or expedited) and the procedure date classify the request, its documents and its clocks.
Chase and verify the clinical documents
The documents the criteria need are listed specifically (the referral, the relevant clinical notes, the imaging and lab results with dates, the conservative treatment history, the functional assessments) and requested from the provider through their link, chased on a clock that works back from the procedure date and the plan's decision period; each is read on arrival and checked against the criteria (the dates, the findings the criteria name, the treatment tried), with what is missing requested with the specifics.
Decide
The medical reviewer decides in the Decision Desk with the criteria, each document mapped to them and the member's benefits, and only the allowed outcomes: approve with the validity period and the authorized setting and units, approve a modified request, request a peer-to-peer discussion, or deny with the specific clinical reasons, the criteria cited and the appeal rights; a request the criteria clearly meet may be approved by rule where the plan's policy allows.
Write back
The decision is written to the health plan system with the authorization number, the validity, the units and the setting, the provider and the member are notified before the procedure date in the form the rules require, and a denial starts the appeal process with its clock; the claim that follows the procedure matches the authorization.

Where it ends: The authorization was decided before the procedure date on the documents the criteria needed, chased from the provider on a clock, and the health plan system holds the decision the claim will match. The Decision Trace shows the classification, each document against the criteria and the decision; the Audit Trace shows the request, the chases and the notices with time.

Runtime enforcement

What is enforcedwhile the work runs.

The regulations preloaded in Callvu Studio and the bank's own policies, applied as steps that run, not lines in a binder. A step that breaks a rule does not run, so a completed run was compliant.

Regulations

US requirements shown. Ministry of Health runs this process under national rules outside the US; Callvu loads each market's rules as policies the same way.

Payer rules: The health plan's prior authorization rules define the procedures and services that require authorization, the clinical criteria and medical policies applied, the documentation required, the decision periods for standard and urgent requests (under the plan's rules and the applicable regulations, for example the NAIC Utilization Review Model Act periods or the national prior authorization timeframes), the notice contents for approvals and denials, the peer review and the appeal rights, and the validity period of an authorization.
Utilization review and appeal rules (the NAIC Health Carrier Utilization Review Model Act and the national patient protection rules as adopted): Utilization review must apply written clinical criteria, be conducted by qualified clinicians with an adverse determination made by a physician, provide the notice with the reasons and the criteria, and offer an internal appeal and an external review within the periods; expedited review applies where the delay would jeopardize the member's health.
Health information privacy (the applicable health privacy law) and the plan's data handling: Clinical documents are protected health information exchanged for treatment, payment and operations, masked in the process outside the clinical review and retained under the plan's policy.

Company policies

The documents are listed from the criteria at the start; the provider is never asked in rounds.
The chase works back from the procedure date, not from the submission date.
The reviewer decides with every document mapped to the criteria; a denial cites the criteria and the rights.
The health plan system is the system of record for the authorization the claim will match.

Controls

Procedure, criteria and urgency classification.
Criteria-driven document list.
Provider chase on a date-driven clock.
Document reading and criteria mapping.
Decision Desk decision with required outcomes and notice generation.
Health plan system write and appeal trigger.

Clocks and deadlines

Decision period: The payer's standard and expedited periods from the complete request.
Procedure date: The real deadline; the chases and the decision are scheduled against it.
Authorization validity: The period the approval covers, written with it.

Documents and checks

The request and its classification
The criteria and the document list
Each clinical document as received and mapped
The decision with the reasons and the rights
The health plan system record and the notices

In the Decision Trace

The criteria applied and each document's mapping.
The decision and the reviewer.
The urgency classification.

In the Audit Trace

The request with time against the procedure date.
Each chase and arrival with time.
The write and the notices.

The handoff

Between the front doorand the back office.

The front door

The provider's link or the scheduling system's feed; the member sees status and the decision.

The back office

The medical reviewer opens a request with the documents mapped to the criteria; the plan's clocks run on the record.

The Decision Desk

Every authorization the plan's policy does not approve by rule goes to the medical reviewer in the Decision Desk with the criteria and the documents, and only approve, approve modified, peer-to-peer, or deny with reasons and rights.

Proof

Live at Ministry of Health.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.

The Ministry of Health 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 the Ministry of Health, 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

At the Ministry of Health, Callvu integrated with very old legacy systems at several hospitals, and brings ERP, CRM and EHR data into one experience.

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

Questions

What buyers ask next,answered plainly.

What documents are requested?

Exactly what the clinical criteria for the procedure need: the referral, the relevant notes, the imaging and labs, the conservative treatment history; listed at the start and chased from the provider on a clock set from the procedure date.

Who decides?

The medical reviewer in the Decision Desk with every document mapped to the criteria; a request the criteria clearly meet may be approved by rule where the plan allows.

What does a denial include?

The specific clinical reasons, the criteria cited and the appeal rights, with the appeal process started on its clock.

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