Surgical Outpatient Network Reduced Time for Prior Authorization by 46%

The Client Profile

• Industry: Outpatient Rehabilitation

• Headquarters: Idaho

• Organization Size: Approximately 1,100 employees

• Operational Footprint: Montana, Idaho, Oregon, Washington, and Wyoming

• Engagement Focus: Prior authorization automation, AI-assisted documentation, systems integration, and compliance

A regional outpatient rehabilitation practice provides therapy and rehabilitation services across five states. With approximately 1,100 employees supporting a growing network of locations, the organization processes thousands of patient visits each month.

The Challenge

Inconsistent Prior Authorization Processes Delayed Patient Care

Many of our client's patient's visits required prior authorization from commercial insurers, Medicare Advantage plans, Medicaid programs, and other payers. Requirements varied considerably by payer, plan, treatment type, and state. Some authorizations required clinical evaluations, physician orders, treatment plans, progress notes, diagnosis codes, or evidence of medical necessity.

Employees relied on spreadsheets, email, payer portals, shared documents, and manual follow-up to manage authorization requests. Without a centralized system, teams struggled to determine which requests were complete, which required additional documentation, and which were approaching expiration or service limits.

The fragmented process created several operational challenges:

• Payer requirements were difficult to track and changed frequently.

• Documentation was often incomplete when authorization work began.

• Employees repeatedly searched across systems for clinical and insurance information.

• Requests were not always assigned to the correct specialist immediately.

• Staff lacked a centralized view of pending, submitted, approved, denied, and expiring authorizations.

• Delayed approvals disrupted scheduled therapy and created gaps in patient care.

• Managers could not easily balance workloads across authorization teams.

• Leadership lacked reliable reporting on turnaround times, denial causes, payer performance, and delayed appointments.

• Manual tracking made it difficult to maintain consistent documentation and complete audit histories.

As patient volume increased, the organization needed a scalable way to coordinate prior authorizations across its entire network. The solution needed to improve speed and consistency while ensuring qualified employees retained control over payer submissions and patient-care decisions.

The Solution

An AI-Assisted Prior Authorization Platform Built with Quickbase, Workato, and Claude

Quandary Consulting Group designed and implemented a centralized prior authorization operations platform using Quickbase, Workato, and Claude. The solution coordinated the entire administrative authorization lifecycle while connecting employees with the clinical, insurance, and operational information required to process each request.

Centralized Authorization Management in Quickbase

Quickbase became the organization’s central operations platform for managing prior authorizations across every location and state. Each authorization was captured in a standardized record containing:

• Patient and appointment information

• Treating location and assigned provider

• Insurance plan and payer

• Diagnosis and procedure codes

• Requested therapy services

• Number and frequency of requested visits

• Required clinical documentation

• Submission and follow-up dates

• Authorization status

• Approved visit limits

• Effective and expiration dates

• Denial and appeal information

• Assigned authorization specialist

Every request moved through a clearly defined workflow, from initial identification and documentation review through payer submission, approval, denial, escalation, or renewal.

Role-based work queues showed employees exactly which cases required their attention. New requests were routed to the correct authorization specialist based on payer, location, state, and service type. Managers could reassign work when volumes increased or employees were unavailable.

Dynamic Payer Documentation Checklists

Quandary configured documentation checklists that adapted to the requirements of each payer, plan, and treatment type. When a new request entered the platform, the system identified the applicable requirements and generated a tailored checklist. Depending on the authorization, required materials could include:

• Physician referrals or orders

• Initial evaluations

• Treatment plans

• Progress notes

• Diagnosis and procedure codes

• Medical-necessity documentation

• Functional assessments

• Prior treatment history

• Requested visit frequency and duration

• Supporting imaging or specialist records

The platform prevented incomplete cases from being treated as submission-ready. If documentation was missing, the request entered an exception workflow that identified the outstanding item, assigned responsibility, and generated follow-up reminders.

This helped employees resolve documentation gaps earlier—before they delayed a scheduled appointment or caused an avoidable denial.

AI-Assisted Administrative Review with Claude

Claude was incorporated as an assistive document-intelligence layer. It helped authorization specialists review approved clinical and administrative materials without independently making coverage, clinical, or submission decisions. Claude analyzed available documents and created a concise case summary containing relevant information such as:

• Primary diagnosis

• Functional limitations

• Requested rehabilitation services

• Treatment frequency and duration

• Prior response to therapy

• Documented medical necessity

• Progress toward established goals

• Relevant payer requirements

• Potentially missing or inconsistent information

Claude compared the available materials with the applicable documentation checklist and highlighted items requiring employee review. It also prepared draft authorization narratives using information contained in the approved patient record.

Qualified employees reviewed every AI-generated summary and draft before it was used. Authorization specialists retained full authority over the final narrative, supporting documentation, payer submission, escalation, and appeal. This human-in-the-loop structure increased administrative efficiency while protecting professional judgment and accountability.

Workflow Orchestration + Workato Integrations

Workato connected the authorization platform with the organization’s existing clinical, scheduling, document-management, and communication systems. Automated workflows transferred approved information between systems and triggered the appropriate action when an authorization changed status. Depending on the workflow, Workato could:

• Create an authorization request when qualifying care was scheduled.

• Retrieve approved patient, payer, and appointment information.

• Route clinical documents to the correct authorization record.

• Notify specialists when documentation became available.

• Update scheduling teams when authorization was approved.

• Alert employees when additional payer information was requested.

• Escalate requests approaching internal turnaround-time thresholds.

• Trigger renewal workflows before approved visits were exhausted.

• Record authorization status changes in connected systems.

This integration reduced duplicate data entry and helped ensure that authorization, clinical, and scheduling teams worked from consistent information.

Proactive Exception and Expiration Management

The platform continuously monitored requests for conditions that could affect scheduled care. Automated alerts notified employees when:

• Required documentation was missing.

• A payer had not responded within the expected timeframe.

• An authorization was approaching expiration.

• Approved visits were nearly exhausted.

• A scheduled appointment lacked confirmed authorization.

• A request was denied or required additional information.

• A case remained inactive beyond an established threshold.

• An appeal or peer review required action.

Instead of manually checking every open request, employees could concentrate on exceptions with the greatest operational or patient-care impact.

Leadership Dashboards and Governance Controls

Quickbase dashboards gave managers and executives real-time visibility into prior authorization operations across the five-state network. Leadership could monitor:

• Authorization volumes by payer, state, clinic, and service type

• Pending and aging requests

• Average turnaround time

• Upcoming expirations

• Delayed appointments

• Approval and denial rates

• Common denial reasons

• Requests requiring additional documentation

• Employee and team workloads

• Payer response trends

• Renewal and appeal activity

Role-based security limited employees to the information required for their responsibilities. Detailed histories documented assignments, status changes, notes, approvals, AI-assisted outputs, employee validation, and submission activity.

The Results

Faster Authorizations and Fewer Disruptions to Patient Care

46% Reduction in Authorization Turnaround Time

Automated routing, standardized checklists, AI-assisted document review, and proactive exception management reduced authorization turnaround time by 46%. Complete requests reached the appropriate specialists sooner, while documentation gaps were identified earlier in the process.

Fewer Delayed Patient Appointments

Scheduling and authorization teams gained a shared view of approval status, outstanding requirements, visit limits, and expiration dates. Proactive alerts gave employees more time to resolve authorization issues before they interrupted scheduled rehabilitation services.

Improved Payer Documentation Accuracy

Dynamic checklists helped employees assemble the correct materials for each payer and treatment type. Claude-assisted reviews highlighted potentially missing or inconsistent information, while qualified specialists validated every request before submission.

Increased Staff Productivity

Employees spent less time searching through documents, manually creating summaries, entering information across multiple systems, and checking the status of routine requests. Exception-based workflows allowed specialists to focus on complex cases, denials, appeals, and payer follow-up.

Stronger Compliance and Audit Readiness

Role-based access, standardized approvals, employee validation, and detailed activity histories created a consistent record of how each authorization was prepared and processed. Leadership gained greater confidence that AI-supported work remained subject to appropriate human oversight.

Greater Operational Visibility

Real-time dashboards gave leadership a network-wide view of authorization performance, payer trends, employee workloads, and causes of delay. Managers could identify bottlenecks sooner, allocate resources more effectively, and improve processes across locations.

Ultimately, the platform helped the organization process prior authorizations faster, reduce administrative friction, and protect continuity of care across its outpatient rehabilitation network.