Getting started with Referral & Prior Auth Gateway

The Referral & Prior Auth Gateway sits between your EHR and payers. It checks coverage for each referral or order, works out whether the payer needs prior authorization, assembles and submits the request electronically where the payer accepts it, and tracks every request to a decision. Nothing waits unnoticed in a fax tray, a payer portal or someone's inbox.

What it is for

Prior authorization is still largely manual. Staff check coverage in one place, look up payer rules in another, gather notes from the EHR, submit through a mix of portals, phone and fax, then chase status by hand. When a step is missed, the patient's appointment moves or the claim is denied after the service.

• Coverage problems are often found on the day of service, when there is no time to fix them.
• Each payer has its own rules and submission channel, and they change often.
• Requests for more information arrive by fax or portal message and are easy to miss.
• Authorizations expire or are tied to a different provider or site, which surfaces only when the claim is denied.

Who uses it

• Referral coordinators and prior authorization specialists
• Patient-access and scheduling teams
• Revenue-cycle and denial-management leaders
• Clinic and department managers
• Clinicians and their staff, who supply documentation when asked

Before you start

• Your organization licenses Referral & Prior Auth Gateway from Moraph.
• A Moraph client account in that organization, signed in.
• Access to Referral & Prior Auth Gateway in Moraph Apps, given by an administrator in the Moraph Portal under People and access.
• For setup: the product administrator role.

Steps to get started

1. Sign in at app.moraph.com with your Moraph account.

2. Open Referral & Prior Auth Gateway from the launcher. The first time anyone opens it, its workspace is created from the default described in Workspace reference.

3. Check your role: what you can see and do depends on it. See Roles and permissions.

4. Product administrators: work through Set up Referral & Prior Auth Gateway before your team starts.

5. Everyone else: start with Everyday tasks.

Where to go next

• Set up Referral & Prior Auth Gateway
• Everyday tasks
• Connect your systems
• Security, data and compliance
• Troubleshooting and the support guide
• Product overview on moraph.com