Preauthorizations

Copy page

Preauths Process Guide: Pre-Authorization Cancellation Workflow

Preauths Process: Cancelling a Pending Pre-Authorization Request

1. Overview

This guide explains the Pre-Authorization Cancellation workflow, which allows healthcare facilities to formally close or cancel a pending pre-authorization request that was initiated but will no longer be pursued or submitted to the Social Health Authority (SHA) for review.

This workflow is essential for maintaining data integrity, and clearing the facility's queue of open preauths that are no longer valid.This provides a true reflection of the patient's visit.

1.1. What This Workflow Does

The Pre-Authorization Cancellation workflow enables users to:

• Identify the Target Preauth: Use a valid, active consent_token and the specific intervention_code to uniquely identify the pending pre-authorization request.
• Validate Cancel Status: Ensure the identified pre-authorization is in a state that permits cancellation (preauths in DRAFT status).
• Execute Status Change: Update the status of the pre-authorization request to CANCELLED.

1.2. Why This Workflow Is Critical

• Data Integrity: Formally cancelling preauths opened by mistake ensures that the facility's records accurately reflect the services the patient is actually receiving or pursuing.
• Queue Management: Clears the system of unnecessary or erroneously opened preauth requests.
• Preventing Accidental Submissions: Avoids mistaken submission of an incorrect preauthorization requests for review by the payer.
• Auditability: Provides a clear audit trail for cancelled preauthorization requests.

---

2. Workflow Details: Cancelling a Preauth Request

2.1. Workflow Description

1. Input Reception: The system receives the patient's current consent_token and the intervention_code linked to the preauthorization request to be cancelled.
2. Preauth Identification: The system identifies the specific pending pre-authorization request using the provided information.
3. Status Validation: The system verifies that the current status of the identified preauth is eligible for cancellation, i.e it should be in DRAFT status only.
4. Status Update: If validation is successful, the preauth status is atomically updated to CANCELLED.
5. Outcome Delivery: A confirmation message and the preauth_id of the cancelled request are returned.

2.2. Workflow Data Dictionary

Field Name	Description	Data Type	Required	Purpose
consent_token	The active token linking to the patient's current visit	String	Yes	Identifies the active patient visit context
intervention_code	SHA-recognized code for the intervention	String	Yes	Uniquely identifies the specific intervention which the pre-authorization request is for.

2.3. Expected Outcomes

Outcome	Description
Success: Preauth Closed	The pre-authorization request was successfully identified and closed.
Failure: Invalid Consent/Visit	The consent_token was invalid, expired, or the visit is no longer active.
Failure: Preauth Not Found	No pending pre-authorization request matched the provided identifiers.
Failure: Invalid Status	The request cannot be closed because it is already in a final state.
Failure: Input Error	Missing or invalid required fields.

---

3. Critical Success Factors for Integration

• Token Accuracy: Ensure the provided consent_token is the correct, currently active token for the patient's visit.
• Intervention Code Precision: The intervention_code must precisely match the code used when the preauth request was originally opened.
• Status Handling: Communicate clearly why a request cannot be cancelled if it is already in a final state.

---