A prior-authorization workflow in Dock looks like this: your team brings the order in from Epic or athenahealth with its own access, the agent drafts the PA packet against the payer's criteria and writes the draft to a Dock row, the clinician approves, and the team submits through your payer portal or RCM tool. If the payer denies, the same row holds the appeal draft, the citations to clinical evidence, and the clinician sign-off. Every step is attributed to an agent or a human, with a timestamp the compliance team can replay.
Healthcare data is sensitive. Hold any tool, Dock included, to your own HIPAA policies and your compliance team's review before you connect clinical systems.
Epic, athenahealth, and your payer portal or RCM tool stay the systems of record for the raw clinical and payer data. Dock holds the work around that data: what the agent interpreted, the reasoning, and who approved it. Each Dock row carries epic_order_id, athena_encounter_id, or submission_id, plus the agent, the clinician reviewer, the decision, and the timestamp. When the team needs current state, including a fresh denial letter or an updated criteria document, it pulls it from the source rather than trusting the row the agent wrote yesterday.
The PA queue surface
| pa_row | patient | service | epic_order_id | submission_id | agent_draft | reviewer | status | payer_decision |
|---|---|---|---|---|---|---|---|---|
| pa_8821 | R. Lin | MRI lumbar w/o contrast | epic_ord_44910 | sub_77231 | drafted by ved-clin-1 against Aetna LCD L34762 | Dr. Patel | approved | approved 2026-05-28 |
| pa_8822 | M. Cruz | Dupilumab 300mg | athena_enc_5582 | sub_77244 | drafted by ved-clin-1, cites NEJM step-therapy exception | Dr. Okafor | submitted | denied 2026-05-27, appeal opened pa_8823 |
| pa_8823 | M. Cruz | Dupilumab appeal | athena_enc_5582 | sub_77251 | appeal letter cites prior failed therapies in chart | Dr. Okafor | approved | pending |
The row is the interpretation. The pointer columns are how anyone, including an auditor, gets back to the source of truth.
One worked appeal
Patient M. Cruz is denied dupilumab on first submission. The team pulls the athenahealth encounter again, and the agent works through the documented failures of topical steroids and methotrexate, drafts an appeal letter that cites the payer's own step-therapy exception language, and writes the draft to row pa_8823. Dr. Okafor opens the row, reads the cited chart sections inline, edits one paragraph, and approves. The clinician's signature is the gate: the team sends the appeal through the payer portal only once it is on the row. When the payer responds, the team records the decision on the same row, next to the agent's draft rather than over it.
Why this matters
The AMA reports that 24% of physicians say prior authorization has led to a serious adverse event for a patient in their care, including hospitalization, permanent impairment, or death, and that practices spend roughly 12 hours per physician per week on PA work (AMA 2024 survey). The bottleneck is rarely the first draft. It is the appeal, the re-keying, and the lost paper trail when a denial sits in a fax queue for ten days.
CMS-0057-F now requires impacted payers to send standard prior-authorization decisions within seven calendar days and urgent ones within seventy-two hours (CMS Interoperability and Prior Authorization Final Rule). That clock only helps if the provider side can move at the same speed, with attribution intact. A Dock row that names the agent, the clinician, and the payer turn by turn gives your compliance team a clear record to review.
Hand-merged PDFs and shared inboxes lose that record. An attributed row keeps it.
See the pillar at Dock for healthcare operations for the rest of the cluster, and Dock for compliance for how the same attribution model supports compliance review. The pattern under it all is agent identity and agent audit and compliance, with the same reviewer fields that show up in compliance workflows and the same sign-off model in agent identity.
Run your next denial appeal as a Dock row. Attribution, citations, and clinician sign-off in one place.
FAQ
Does Dock replace Epic, athenahealth, or our payer portal? No. Those remain the systems of record for orders, encounters, and payer submissions. Dock holds the agent's interpretation and the human review, linked by ID.
Who is accountable for the appeal letter? The clinician who approves the row. The agent is named as drafter, but the decision attribution sits with the reviewer, with a timestamp.
What happens when payer criteria change mid-appeal? Pull the current criteria document from the payer or your RCM tool before each run. If a citation in an old row is out of date, send the row back for re-review rather than reusing it.
Can compliance replay a specific PA from start to finish? Yes. The row holds every draft, every reviewer sign-off, and the pointer back to the Epic order and the payer submission, so your compliance team can follow the timeline in one place.