Workflow

Pre-authorizations, end-to-end.

Vetra's PA engine handles urgency tiers, SLA timers, auto-approval rules, auth codes, appeals and ghost-patient alerts — across all four portals.

The HMO PA queue with urgency tiers, SLA countdown timers and matching auto-approval rules

Screenshot — coming soon

The HMO authorizations queue, ranked by urgency and SLA.

Urgency tiers

ROUTINEStandard SLA. Used for planned, non-urgent procedures.
URGENTShorter SLA, prioritized in the HMO queue.
EMERGENCYFastest SLA. Triggers a ghost-patient alert to the enrollee.

Auto-approval rules

Define rules per plan, per procedure (or procedure family). A submission that matches the rule is approved instantly and an auth code is issued — no human in the loop.

  • Bounds: rules can carry value ceilings and frequency limits.
  • Audit: even auto-approvals are recorded and visible in the Authorisation report.
  • Override: rules can be disabled per provider or per plan tier when needed.

The auto-approval rule editor — plan, procedure family, value ceiling and frequency limit

Screenshot — coming soon

An auto-approval rule, ready to save.

Auth codes

Once a PA is approved (by rule or human), an auth code is issued. The provider presents it when the claim is later filed; Vetra matches the claim to the PA automatically.

Appeals

Rejected PAs can be appealed by the provider with additional context. The appeal re-enters the queue with the original PA, the rejection reason, and the new evidence attached.

Ghost-patient alerts

EMERGENCY PAs notify the cardholder

When an EMERGENCY pre-auth is filed against an enrollee's card, the enrollee receives a real-time push in their portal. If the visit isn't theirs, they can flag it directly to the HMO — catching misuse before the claim is even submitted.

The ghost-patient alert as it appears in the enrollee portal — provider, time, urgency and a Not me action

Screenshot — coming soon

The enrollee's view of an emergency PA — a Not me action is one tap away.

Notifications across the portals

  • Provider — PA decisioned, auto-approved, appeal decisioned.
  • HMO — new PA in queue, SLA breach approaching, appeal raised.
  • Enrollee — PA raised on their card (especially emergency), decision made.
  • Corporate — aggregate PA volumes via the dashboard.

Watch the PA flow

A pre-auth from request to auth code

Provider requests, HMO decisions (or rule auto-approves), enrollee receives the alert.

Walkthrough — coming soon

PreviousClaims lifecycleNext Settlements & finance