Information related to the patient's coverage, including whether a service is covered, requires prior authorization, is approved without seeking prior authorization, and/or requires additional documentation or data collection

The payer might provide an unsolicited approval of the service as having prior authorization requirements met without a formal submission of a prior authorization request

Information about what steps need to be taken to submit a claim for the service

Allows a provider to update the patient's coverage information with additional details from the payer (e.g. expiry date, coverage extensions)

Messages warning about the patient approaching or exceeding their limits for a particular type of coverage or expiry date for coverage in general

Providing information about in-network providers that could deliver the order (or in-network alternatives for an order directed out-of-network)

Guidance on whether appropriate-use documentation is needed

What is the anticipated cost to the patient based on their coverage

Are there alternative therapies that have better coverage and/or are lower-cost for the patient

Are there alternative therapies that must be tried first prior to coverage being available for the proposed therapy

Reminders that a patient is due for certain screening or other therapy (based on payer recorded date of last intervention)

Notice that the proposed intervention has already recently occurred with a different provider when that information isn't already available in the provider system

Notice that the proposed intervention may be contraindicated based on information the payer has in their record that the provider doesn't have in theirs

Indication that there is a guideline available for the proposed therapy (with an option to view)

Notice that the proposed therapy may be contrary to best-practice guidelines, typically with an option to view the relevant guideline