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Submit a new authorization

Provide the minimum VCS needs to start clinical review. Required fields are marked *.

Patient

Full name

Payer

Insurance carrier Use the carrier name exactly as the practice knows it.

Procedure / CPT

Procedure name

CPT / HCPCS code Optional. Letters and digits, 3–10 characters.

Referring provider

Name and credentials Optional. Captured with the case for clinical context.

Brief clinical context

Notes for clinical review Optional. Free text up to 4,000 characters.

This case will appear in your /portal status feed immediately after submission.