elevia — Insurance Pre-Auth Agent

1

Auth Request Triggered

EHR order detected

CPT 50200 auth check

Payer rule match confirmed

2

Clinical Data Extraction

Pull labs & diagnosis codes

Pull prior visit history

Verify ordering provider NPI

3

Payer Rules Lookup

Query UHC coverage policy

Validate criteria met

Confirm submission channel

4

Auth Packet Submission

Assemble clinical packet

Submit via UHC portal API

Reference number issued

5

Status Polling

Day 1–3: polling daily

Day 4: no decision

Auto-escalate — P2P request

6

Peer-to-Peer Review

UHC requests P2P call

Schedule nephrologist call

Prepare clinical summary

7

Decision Received

Auth decision logged

Syncing to Epic EHR

Procedure scheduling triggered