Prior Authorization and Pre-Certification
This dataset provides detailed records of prior authorization and pre-certification requests for healthcare procedures, medications, imaging, and durable medical equipment, including approval status, reference numbers, and validity dates for claims processing. It enables comprehensive tracking, auditing, and analytics for healthcare providers, payers, and administrators to optimize claims workflows and regulatory compliance.
Sample rows
preview · 8 of 100 rows · all 16 columns| authorization_idstring | authorization_typestring | requested_quantityinteger | patient_idstring | provider_idstring | request_datedate | service_codestring | service_descriptionstring | approval_statusstring | approval_datedate | valid_from_datedate | valid_to_datedate | reference_numberstring | payer_idstring | diagnosis_codestring | notesstring |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| AUTH0001-2024A | procedure | 1 | PAT19873 | PRV3112 | 2024-04-05 | CPT99214 | Office visit, established patient | approved | 2024-04-07 | 2024-04-08 | 2024-10-08 | REF-PA-354821 | PAY0445 | I10 | Routine checkup, hypertension management |
| AUTH0002-2024A | medication | 30 | PAT20456 | PRV2900 | 2024-04-12 | NDC00615-1522-13 | Atorvastatin 20mg tablet | approved | 2024-04-13 | 2024-04-13 | 2024-07-13 | REF-PA-354822 | PAY0092 | E78.5 | Lipid panel above goal, statin therapy |
| AUTH0003-2024A | imaging | 1 | PAT21234 | PRV3112 | 2024-04-14 | CPT72148 | MRI lumbar spine w/o contrast | denied | 2024-04-16 | 2024-04-14 | 2024-07-14 | REF-PA-354823 | PAY0211 | M54.5 | Insufficient clinical documentation |
| AUTH0004-2024A | DME | 1 | PAT19873 | PRV4502 | 2024-04-21 | HCPCS E0607 | CPAP device | pending | blank | 2024-04-21 | 2024-10-21 | REF-PA-354824 | PAY0445 | G47.33 | Awaiting sleep study results |
| AUTH0005-2024A | procedure | 1 | PAT22879 | PRV2900 | 2024-04-15 | CPT45378 | Diagnostic colonoscopy | approved | 2024-04-17 | 2024-04-18 | 2024-07-18 | REF-PA-354825 | PAY0092 | K63.89 | Family history of colon cancer |
| AUTH0006-2024A | medication | 60 | PAT17654 | PRV3112 | 2024-04-18 | NDC00054-3542-25 | Metformin 500mg tablet | partial | blank | 2024-04-19 | 2024-10-19 | REF-PA-354826 | PAY0445 | E11.9 | Partial approval, step therapy required |
| AUTH0007-2024A | imaging | 1 | PAT23456 | PRV1509 | 2024-03-29 | CPT70450 | CT head w/o contrast | approved | 2024-03-31 | 2024-03-31 | 2024-06-30 | REF-PA-354827 | PAY0211 | S06.0X0A | Head injury, rule out fracture |
| AUTH0008-2024A | DME | 2 | PAT21234 | PRV3112 | 2024-04-10 | HCPCS E0114 | Crutches, forearm | approved | 2024-04-12 | 2024-04-12 | 2024-10-12 | REF-PA-354828 | PAY0445 | S82.202A | Fracture, right tibia |
| AUTH0009-2024A | procedure | 1 | PAT17654 | PRV1509 | 2024-04-01 | CPT93000 | Electrocardiogram, routine | approved | 2024-04-02 | 2024-04-03 | 2024-06-03 | REF-PA-354829 | PAY0211 | I48.91 | Atrial fibrillation assessment |
| AUTH0010-2024A | medication | 90 | PAT22879 | PRV4502 | 2024-04-05 | NDC00093-5127-01 | Lisinopril 10mg tablet | approved | 2024-04-06 | 2024-04-07 | 2024-07-07 | REF-PA-354830 | PAY0092 | I10 | Newly diagnosed hypertension |
| AUTH0011-2024A | procedure | 1 | PAT19873 | PRV3112 | 2024-04-17 | CPT29881 | Knee arthroscopy w/ meniscectomy | pending | blank | 2024-04-18 | 2024-07-18 | REF-PA-354831 | PAY0445 | M23.21 | Awaiting surgical clearance |
| AUTH0012-2024A | DME | 1 | PAT20456 | PRV1509 | 2024-04-20 | HCPCS E1399 | Miscellaneous DME | partial | blank | 2024-04-21 | 2024-10-21 | REF-PA-354832 | PAY0211 | R26.89 | Partial approval for limited equipment |
| AUTH0013-2024A | imaging | 1 | PAT23456 | PRV3112 | 2024-03-30 | CPT74177 | CT abdomen & pelvis w/ contrast | approved | 2024-03-31 | 2024-04-01 | 2024-07-01 | REF-PA-354833 | PAY0445 | R10.9 | Abdominal pain, rule out appendicitis |
| AUTH0014-2024A | procedure | 1 | PAT17654 | PRV2900 | 2024-04-03 | CPT93010 | Electrocardiogram interpretation | approved | 2024-04-04 | 2024-04-05 | 2024-07-05 | REF-PA-354834 | PAY0092 | I48.91 | Cardiology consult |
| AUTH0015-2024A | medication | 30 | PAT21234 | PRV3112 | 2024-04-13 | NDC00078-0616-15 | Omeprazole 20mg capsule | denied | 2024-04-15 | 2024-04-16 | 2024-07-16 | REF-PA-354835 | PAY0445 | K21.9 | Formulary exclusion |
| AUTH0016-2024A | DME | 2 | PAT23456 | PRV4502 | 2024-04-11 | HCPCS E0117 | Crutch, underarm | approved | 2024-04-12 | 2024-04-13 | 2024-10-13 | REF-PA-354836 | PAY0092 | S82.202A | Broken left leg, post-op recovery |
| AUTH0017-2024A | imaging | 1 | PAT22879 | PRV3112 | 2024-04-07 | CPT70551 | MRI brain w/o contrast | approved | 2024-04-08 | 2024-04-09 | 2024-07-09 | REF-PA-354837 | PAY0445 | G43.909 | Migraine evaluation |
| AUTH0018-2024A | procedure | 1 | PAT20456 | PRV1509 | 2024-04-18 | CPT99203 | Office visit, new patient | approved | 2024-04-19 | 2024-04-20 | 2024-07-20 | REF-PA-354838 | PAY0211 | R05 | Cough, suspected URI |
| AUTH0019-2024A | medication | 90 | PAT17654 | PRV2900 | 2024-04-04 | NDC00143-9646-01 | Levothyroxine 75mcg tablet | pending | blank | 2024-04-05 | 2024-07-05 | REF-PA-354839 | PAY0092 | E03.9 | Awaiting thyroid panel |
| AUTH0020-2024A | DME | 1 | PAT21234 | PRV3112 | 2024-04-16 | HCPCS E0143 | Walker, folding, wheeled | approved | 2024-04-17 | 2024-04-18 | 2024-10-18 | REF-PA-354840 | PAY0445 | R26.89 | Gait instability, post-stroke |
What the 100 rows show
from the 100-row sampleMedication (authorization type) stands out: mean requested_
- 1median requested_
quantity - 4approval statuses
- 9payers
- 11providers
Median 1, from 1 to 100.
- string 11
- integer 1
- date 4
Columns
16 columns in three groups| column | type | description | example |
|---|---|---|---|
| Text 11 columns | |||
authorization_id | string | Unique identifier for the prior authorization requestunique | AUTH0001-2024A |
patient_id | string | Unique identifier for the patient associated with the request | PAT19873 |
provider_id | string | Unique identifier for the healthcare provider submitting the request11 providers | PRV3112 |
authorization_type | string | Type of authorization requested (procedure, medication, imaging, DME)procedure · medication · imaging · DME | procedure |
service_code | string | Code representing the requested service, medication, or equipment (e.g., CPT, HCPCS, NDC) | CPT99214 |
service_description | string | Description of the requested procedure, medication, imaging, or equipment | Atorvastatin 20mg tablet |
approval_status | string | Current status of the authorization requestapproved · denied · pending · partial | approved |
reference_number | string | Reference number provided by payer for tracking the authorizationunique | REF-PA-354821 |
payer_id | string | Unique identifier for the insurance payer processing the authorization9 payers | PAY0445 |
diagnosis_code | string | Primary diagnosis code (e.g., ICD-10) associated with the authorization requestoptional | I10 |
notes | string | Additional notes or comments related to the authorization requestoptional | Fracture, right tibia |
| Numbers 1 column | |||
requested_quantity | integer | Quantity of the service, medication, or equipment requested1 or more · optional | 1 |
| Dates and times 4 columns | |||
request_date | date | Date the prior authorization request was submitted | 2024-04-05 |
approval_date | date | Date the authorization was approved or deniedoptional | 2024-04-07 |
valid_from_date | date | Start date for which the authorization is valid for claims processing | 2024-04-08 |
valid_to_date | date | End date for which the authorization is valid for claims processing | 2024-10-08 |
Use it for
A healthcare dashboard
Requested_
quantity by authorization_ type and a breakdown of patient_ id. Excel, Power BI or Tableau. Why do the 25 medication rows have a mean requested_
quantity of 39.4? A root-cause class exercise
Hand out the rows and one question. The answer is in the data, not in the brief.
- Authorizations100AUTH0001-2024A1procedureAUTH0002-2024A30medicati…AUTH0003-2024A1imaging
A software demo
Believable authorizations with patient_
id, provider_ id and request_ date to fill a screen in front of a buyer.
This dataset100 rows16 columns
Yours10,000 rows16 columns
blueprint · prior-authorization-and-pre-certification
Behind this dataset
Same schema. As many rows as you need.
These 100 rows came out of a blueprint — 16 columns with generation rules behind each one. Open it in Data Factory to retune a column, add your own, wire in foreign keys, and run it at the size you actually need.
Rules it was built with
- Authorization ID or reference number unique
- Service requested: procedure, medication, imaging, DME, admission
- CPT/HCPCS code for service
- Diagnosis code justifying medical necessity
- Requesting provider with NPI
- Authorization status: pending, approved, denied, partial approval
- Approved units or visits
- Valid from and through dates
Open the blueprint in Data Factory
1 credit per row. New accounts start with 25 free credits.
- Exports
- CSV, JSON, JSONL, Parquet, SQL, Excel, TSV, XML
- Licence
- yours to use, including commercially
- API slug
- prior-authorization-and-pre-certification