Benefits & Prior Authorization Orchestration
Ready before it's submitted. Owned until it's handed off.
A benefits result tells you what coverage exists. It doesn't tell you whether the case is ready to authorize, who is following up, or whether the next team has accepted it.
WRA designs and implements the orchestration around benefits and prior authorization work: evidence readiness, human-controlled submission, follow-up ownership and accepted handoff. The payer remains the decision authority.
A benefits result is not an authorization-ready case
Knowing a patient's coverage is the start of the work, not the end. What decides how fast a case moves is everything between the benefits result and an accepted handoff to pharmacy and scheduling.
Requirements readiness
Which requirements apply to this therapy, payer and site of care, and which ones are already met?
Evidence readiness
Are clinicals, documentation and forms complete before submission, or is the case going out to come back?
Payer waiting vs. internal follow-up
Is the case waiting on the payer, or on something your team controls? The two need different owners and different timers.
Exception and escalation ownership
When a case is pended, denied or stuck, who owns the next move, and by when?
Accepted downstream handoff
Has pharmacy or scheduling accepted the authorized case, or has it only been marked approved?
Prior authorization automation that respects who decides
The payer remains the decision authority. WRA works on what your team controls: readiness, follow-up, ownership and handoffs. Automation and Applied AI are applied where they remove manual work or make the state of each case visible.
- Requirement and evidence checklists by payer and therapy, visible per case before submission.
- Human-controlled submission: staff review and submit where your process and the payer require it.
- Separate tracking of payer-pending time and internally controllable follow-up.
- Owner, next action and elapsed time for every pended, denied or escalated case.
- An explicit, accepted handoff to pharmacy operations and scheduling.
- Electronic submission and status checks where the payer and your systems support them, not assumed everywhere.
Clear boundaries, stated up front
- WRA does not make or influence payer decisions.
- WRA does not guarantee approvals, faster payer turnaround or fewer denials. We make your side of the process visible, owned and ready.
- Electronic prior authorization support varies by payer, program and system, and is confirmed during scoping.
- Your benefits, pharmacy and EHR systems remain the systems of record.
From a conversation to a scoped decision
- Discuss a healthcare workflow. A short qualification conversation about one workflow: where cases stall, who owns them, and which systems are involved. No cost, no commitment, and not an assessment.
- Operational Systems Assessment. If there's a fit, WRA's fixed-scope assessment maps one case type as it actually runs (data, handoffs, ownership, exceptions) and ends with a written recommendation. Scope, timeline and price →
- Bounded pilot, only if warranted. Success criteria and the end decision (stop, adjust, expand or operate) are agreed before anything is instrumented.