Overview

The authorization processing overview is shown in the image below.

When an authorization is submitted for processing, the authorization status is set to 'In Process'. The authorization status history, authorization pend reasons, authorization pend reason history and authorization messages are also updated. This is described in detail in the subsequent section Submit Authorization of the guide.

The system then initiates a call out to an external system to gather the person’s or object’s enrollment details through the Enrollment Integration Point. The enrollment details are stored in Oracle Health Insurance Authorizations as described in the section Enrollment Callout.

In the next step, the system determines and evaluates the configured Process Steps. A process step contains Rule Steps. The rule steps identify which Process Rules - Callout Rules, Event Rules, Validation Rules and/or Pend Rules - are to be executed within a process step and its order of execution within the step. At the end of a process step an authorization may arrive at the status 'Pended' with the processing suspended for manual intervention or it moves to the evaluation of the next process step until the last process step is executed.

If any technical error is encountered during the execution of the process step, the processing flow is suspended with a technical error and the authorization is then available in View Technical Error page. From this page the processing can be restarted after the technical errors are resolved.

More detail on the processing of the process steps and rules is described in the section Process Rules of the guide.

After execution of all the process rules, the system executes the final step in processing Finalize. During this step the system determines if the authorization is 'Approved' or 'Denied'. An 'Approved' or 'Denied' authorization can be 'Unfinalized' if required. Unfinalizing an authorization creates a new version and makes it possible to modify the authorization and reprocess it.

Authorization Statuses

The status of an authorization reflects the authorization’s position in the flow. An authorization can have only one status at a time.

The following authorization statuses exist:

Status	Description
Entry	The authorization has been entered and saved, but not yet submitted
In Process	The authorization is being processed
Pended	The authorization attains this status when it is pends as a result of a configured pend rule. Processing is suspended
Changed	An authorization that was submitted earlier can now be edited and resubmitted for processing
Approved	The authorized is approved
Denied	The authorization is denied

The authorization status flow is shown in the picture below