Authorization Review & Automation

To automate authorizations, your team must first map procedure codes, diagnosis requirements, provider types, places of service, and plan-specific coverage rules. VA Live relies on this configuration to understand which services require prior auth, which conditions must be met, and which requests are eligible for straight-through processing. This upfront mapping ensures that Medicare, Medicaid, and commercial policies are applied correctly and consistently across all authorization requests.

Not every authorization should be automated. VA Live requires clear thresholds for when requests are approved, denied, pended, or escalated to clinical staff. Plans define what qualifies as routine versus complex, what triggers medical director review, and which scenarios must remain manual. VA Live enforces these guardrails in real time—preventing inappropriate auto-decisions while removing low-risk requests from clinical queues.

Once rules and workflows are defined, VA Live applies real-time validation to every authorization request. Incomplete submissions, non-covered services, policy conflicts, and medical necessity gaps are flagged immediately with clear reasoning and recommended actions. Requests that meet all requirements move forward without delay, while exceptions are routed appropriately—creating faster decisions, fewer appeals, and a defensible audit trail for every determination.

Within 3-10 business days, PCG will stand up a secured VA Live hosted server which will transmit VE authorization determinations back into your authorizations software.