Prior authorization request tracker
A downloadable CSV structure for tracking authorization requests from submission through decision — without embedding patient data in the example.
CSV · Reviewed 2026-07-18
Download and use
The download contains headings and blank rows only. The examples below use fictional operational references so you can see the intended structure without copying patient data.
Column guide
Internal reference
Use a non-PHI internal work reference.
Payer
Payer or review entity.
Service requested
A non-clinical description of the requested service.
Units requested
Units or visits requested.
Requested date range
The service date or window the request covers.
Submitted date
Date the request was submitted.
Channel
Portal, fax, phone, or electronic transaction.
Status
Submitted, pending, approved, denied, or peer-to-peer.
Authorization number
Reference number returned on approval.
Follow-up date
Next planned check against the payer's stated window.
Fictional example
| Internal reference | Payer | Service requested | Units requested | Requested date range | Submitted date | Channel | Status | Authorization number | Follow-up date |
|---|---|---|---|---|---|---|---|---|---|
| AUTH-001 | Example payer | Outpatient procedure | 1 | 2026-08-01 | 2026-07-15 | Portal | Pending | — | 2026-07-22 |
| AUTH-002 | Example payer | Imaging study | 1 | 2026-08-05 | 2026-07-16 | Electronic | Approved | REF-AUTH-2002 | — |
Working instructions
- 1Confirm whether the service requires authorization for the plan, and the payer's current submission requirements, before relying on the tracker.
- 2Record the authorization number, approved units, and approved date range on approval so the eventual claim can be reconciled to them.
- 3Track each request to a decision against the payer's stated timeframe rather than assuming a generic turnaround.
- 4Do not enter patient names, identifiers, or clinical details in an unsecured copy of this file; keep them in the approved secured system.