Andon · Prior auth worksheet

Is your prior auth queue ready for automation?

A 15-minute worksheet for oncology RCM teams. Step 1 scores one prior auth queue against the criteria Andon uses to judge fit. Step 2 estimates what auth gaps cost you each month in revenue, specialist time, and days waiting on payers. Every number comes from you.

PART 1

Pick one prior auth queue

Score one queue at a time, such as infusion drugs or advanced imaging. Mixing service lines blurs the answers.

Queue name Payers covered Drugs or services in scope

PART 2

Score six fit criteria

Pick the description closest to how this queue runs today. Each criterion scores 0 to 3.

Total

0 / 18

PART 3

List your top drugs and services

One row per drug or service that needs auth. This table usually shows where to start, and its totals fill in Part 4 automatically.

Drug or service	Requests / month	Avg charge	% without valid auth	Avg minutes per request	Avg days to decision	$ at risk / month	Hours / month	Remove
Total	0	–	–	–	–	$0	0

“Without valid auth” counts requests denied, expired, or never obtained before the service. Totals use weighted averages.

PART 4

Estimate revenue at risk

Values marked “From Part 3” update as the table changes. Type over any of them to use your own number.

Monthly revenue at risk = auth requests per month × average charge × share ending without valid auth

Specialist hours per month = auth requests per month × average minutes per request ÷ 60

Auth requests per month Average charge $ Share without valid auth % Average minutes per request Average days to decision Working hours per specialist h Per month, used for the FTE estimate

Optional: the downstream cost. Auth gaps that slip through show up later in your denial queue as CO-197 (authorization absent) and CO-15 (authorization number missing or invalid).

Auth-related denials per month From your denial reports Average denied amount for those $ Your estimate

PART 5

What to bring to a prior auth review

Tick these off as you gather them.

The SOP for this queue
Your drug and service table from Part 3
The payer criteria or drug policies your team checks most
Five to ten de-identified auth requests, approved and denied

Revenue and time

Monthly revenue at risk$0$0 a year at this rate

Specialist hours / month0

Full-time specialists0

Avg days to decision0

Auth requests / month0

Auth-related denials downstream–Add your CO-197 and CO-15 counts in Part 4

Andon Fit Score

0 / 18 Not scored yet

Readout

Andon turns prior auth, denial, and appeal SOPs into workflows that run every day. This worksheet is a self-assessment; results depend entirely on the numbers you enter. Also working a denial queue? Score it with the denial workflow worksheet.