NR-0 / OPEN
Assign
NO

If the computer says no, let the computer say no.

The unit sits between the decisioning system and the customer. It delivers the decision. It takes the reply back.

01 — Exhibit

The person in the middle

A prior authorization comes back no. Someone still has to open the chart, find the voice, and say it. The computer decided in a moment. The person spends the rest of the hour inside the answer.

No Robot sits in front of that system. It delivers the decision to the customer, takes the reply, and sends the reply back. It does not reopen the decision. The person goes back to the work that is not this.

02 — Exhibit

What the unit does

  1. TakeThe decision from the decisioning system. The unit does not reopen it.
  2. DeliverThe decision, and what the customer can do next. A person does not read it aloud.
  3. ReceiveAdditional information or an exception. It goes back to the decisioning system.
  4. HoldThe unit does not soften the decision, and it does not pretend the reply changed it.

03 — Exhibit

Specimens

Specimen

File PA-4418

Prior authorization

Request
Outpatient imaging, lumbar
Rule
NR-14 · not medically necessary
Disposition
NO

The criteria set did not match the indication on the request. A person was not assigned to read this aloud.

Specimen

File CL-9021

Claim line

Line
7 · professional services
Allowed
0.00
Disposition
NO

The line falls outside the contracted bundle. The zero was already in the system before anyone opened the file.

Specimen

File EX-118

Coverage window

Request
Exception, formulary
Received
Day 12 of a 10-day window
Disposition
NO

The window is a number. The number had passed. The unit does not extend it to spare someone the sentence.

Composed examples. Not determinations. Not anyone's chart.

Unit

NR-0

The decisioning system has already decided. This unit tells the customer, and takes the reply back. The exchange stays in this browser.

04 — Assignment

Hand the unit a decision.

For the institution. Name the organization, the role that currently has to face the customer, and the decision the decisioning system already made. The desk confirms only after the file is accepted. A notice above is not a filing.