Prior Authorization Tracker
Design a shared tracker that explains an insurance prior authorization from clinical submission through decision and appeal.
The brief
Understand the problem
Background
Patients and clinic staff often cannot tell whether an authorization is waiting on the insurer, missing records, under review, or denied. Vague status labels make delays difficult to act on.
User context
Jamal is waiting for approval of an imaging study. His clinic submitted the request, but the insurer later asked for notes that the patient never saw.
Product problem
All parties need an accurate status, responsible owner, deadlines, and required next action without exposing internal clinical information unnecessarily.
Objective
Create patient and staff views for authorization status, document requests, insurer decisions, and appeal preparation.
What to design
Define the experience
Required experience
- Review the request, coverage basis, and current owner
- Respond to a missing-information request
- Understand an approval or denial decision
- Prepare and track a permitted appeal
Screens and states
- Authorization overview
- Requirement detail
- Decision explanation
- Appeal tracker
Core user flow
Follow the critical path
- 01
Jamal opens the imaging authorization timeline
- 02
He sees that the clinic, not the patient, owes a recent visit note
- 03
Staff upload the note and the deadline updates
- 04
A denial arrives with criteria and an appeal action assigned to the clinician
Product rules
Requirements and constraints
Requirements
- Use event-based statuses with timestamps and responsible party
- Translate insurer codes while retaining the original language
- Separate patient actions from clinic and insurer actions
- Show appeal eligibility, deadline, required evidence, and submission proof
Constraints
- Coverage approval is not the same as appointment booking
- Clinical records need minimum necessary disclosure
- Insurer response estimates must be labeled as estimates
Reality check
States worth considering
Finish line
What to deliver
- Four responsive screens with distinct patient and clinic responsibility states
Optional direction
Visual resources
Use these as a starting constraint if you want one. They are not part of the required solution.