{
  "title": "Actigy BPO Prior Authorization Readiness Checklist",
  "version": "2026-10-18",
  "status": "Operational planning tool, not compliance certification",
  "checks": [
    {
      "check": "Payer scope",
      "suggested_owner": "Billing lead",
      "evidence_required": "Record payer, product, service type, applicable rule and verified compliance date.",
      "status": "Not started",
      "owner": "",
      "evidence": "",
      "next_action": ""
    },
    {
      "check": "Technology route",
      "suggested_owner": "EHR owner",
      "evidence_required": "Confirm the vendor release, enabled features, payer connection and test environment.",
      "status": "Not started",
      "owner": "",
      "evidence": "",
      "next_action": ""
    },
    {
      "check": "Submission evidence",
      "suggested_owner": "Authorization lead",
      "evidence_required": "Demonstrate a request reference, receipt timestamp and retrievable payload record.",
      "status": "Not started",
      "owner": "",
      "evidence": "",
      "next_action": ""
    },
    {
      "check": "Clinical documentation",
      "suggested_owner": "Clinical owner",
      "evidence_required": "Approve the evidence required for the selected service and who may sign it.",
      "status": "Not started",
      "owner": "",
      "evidence": "",
      "next_action": ""
    },
    {
      "check": "Response handling",
      "suggested_owner": "Authorization lead",
      "evidence_required": "Test approval, denial and request-for-information responses.",
      "status": "Not started",
      "owner": "",
      "evidence": "",
      "next_action": ""
    },
    {
      "check": "Urgent routing",
      "suggested_owner": "Clinical owner",
      "evidence_required": "Document how urgency is determined and who handles an approaching deadline.",
      "status": "Not started",
      "owner": "",
      "evidence": "",
      "next_action": ""
    },
    {
      "check": "Exceptions and fallback",
      "suggested_owner": "Operations lead",
      "evidence_required": "Test connection failure, duplicate risk and the permitted alternative channel.",
      "status": "Not started",
      "owner": "",
      "evidence": "",
      "next_action": ""
    },
    {
      "check": "Authorization limits",
      "suggested_owner": "Billing lead",
      "evidence_required": "Capture service, provider, dates, units and expiry conditions for the claim handoff.",
      "status": "Not started",
      "owner": "",
      "evidence": "",
      "next_action": ""
    },
    {
      "check": "Patient communication",
      "suggested_owner": "Practice manager",
      "evidence_required": "Assign the owner of status updates and unresolved scheduling questions.",
      "status": "Not started",
      "owner": "",
      "evidence": "",
      "next_action": ""
    },
    {
      "check": "Access and audit",
      "suggested_owner": "Security owner",
      "evidence_required": "Approve access, evidence retention and revocation procedures.",
      "status": "Not started",
      "owner": "",
      "evidence": "",
      "next_action": ""
    },
    {
      "check": "Performance baseline",
      "suggested_owner": "Reporting lead",
      "evidence_required": "Record queue age, response time, staff effort and open requests by payer.",
      "status": "Not started",
      "owner": "",
      "evidence": "",
      "next_action": ""
    },
    {
      "check": "Launch decision",
      "suggested_owner": "Accountable sponsor",
      "evidence_required": "Review test evidence, unresolved failures and a documented rollback plan.",
      "status": "Not started",
      "owner": "",
      "evidence": "",
      "next_action": ""
    }
  ]
}