How to build a prior authorization tracker for specialty infusion and injectable therapy clinics with AI-classified payer requirements in Formaloo

An internal intake form your prior authorization coordinators fill out for every specialty drug request, capturing the patient, payer, diagnosis, prior therapies, and supporting documentation. The moment a request is submitted, an AI Analysis field reads it against the common documentation requirements for that drug class and flags exactly what's missing, writing a clear readiness verdict onto the record before anyone opens it. From there the request moves through a coordinator pipeline with automatic patient and provider notifications as it's submitted, approved, denied, or appealed, generates an internal case file PDF, and rolls up into an AI-generated denial trend report for clinical leadership.

This is the form your coordinators fill out for every specialty drug request. It captures the patient and provider details needed for notifications, the payer and diagnosis details the AI needs to work with, and the documentation itself. The fastest way to build it is with Magic Create, Formaloo's AI form builder: describe the form in plain text and it generates the fields for you.

1. Open Magic Create: From your Formaloo homepage, click Magic Create.

2. Describe the form: Paste a prompt describing a prior authorization intake form for a specialty infusion or injectable therapy clinic, covering the patient's full name and email, the referring or prescribing provider's name and email, the insurance payer name, the patient's plan or policy number, the diagnosis (ICD-10 code and description), the specialty medication being requested, the requested dosing and frequency, the requested treatment start date, whether the patient has tried and failed other therapies for this condition (with a field to list which ones and the outcome if yes), an upload for chart notes or clinical documentation, an upload for recent lab results, whether this is an expedited or urgent request (with a field to explain the clinical reason if yes), and consent to share this documentation with the payer. Also describe the admin-only fields: a prior authorization status dropdown, an assigned coordinator field, internal notes, a documentation readiness dropdown, and an AI Analysis field that reads the request and flags missing documentation.

3. Click Create: Formaloo builds the full form for you.

4. Verify your fields: Your form should look like this. Magic Create will have generated most of it. Verify each field and field ID matches exactly.

5. Set the Documentation readiness dropdown's choices: Give it two options: "Ready to submit" and "Documentation gaps found."

6. Set the Prior authorization status dropdown's choices: Give it six options in this order: Draft, Submitted to payer, Approved, Denied, Appeal submitted, Closed.

7. Set up the AI documentation analysis field: Open the AI Analysis field's settings and point it at the fields it should read: @payer_name, @drug_requested, @diagnosis, @prior_therapy_tried, @prior_therapy_details, @chart_notes_upload, @lab_results_upload, and @is_expedited. Write a prompt asking it to identify, from its general knowledge of common prior authorization documentation requirements for that drug class and payer type, what supporting documentation this request would typically need, and flag which of those items appear to be missing based on what's actually been uploaded and described. Ask it to end with a one-line verdict: "Ready to submit" or "Documentation gaps found," followed by a short list of what's missing.

Note: the AI's read is based on general knowledge of how specialty drug prior authorizations are typically documented, not a live connection to any specific payer's system. Coordinators should still treat it as a first check, not a replacement for the payer's own submission portal or fax cover sheet.

8. Turn on "Allow AI to update records": In the same field's settings, enable this option and select only the Documentation readiness field. Once a request is submitted, the AI writes "Ready to submit" or "Documentation gaps found" directly onto that dropdown, so the rest of the workflow can react to it with regular logic instead of parsing free text.

9. Save your form.

This is what makes the intake form adapt to the situation instead of asking every coordinator the same questions regardless of relevance. The prior therapy details only show up when they're actually needed, and the expedited reason field only appears for urgent requests.

1. Open Advanced logic: In your form editor, open the Advanced logic panel on the right side of the screen and go to the Logic tab.

2. Open Magic Logic: Click Magic Logic in the top right corner.

3. Describe your rules: Paste a plain-text prompt describing both rules at once: show "List the prior therapies tried and their outcomes" only when "Has the patient tried and failed other therapies for this condition?" is Yes, hidden and optional by default; and show and require "If urgent, explain the clinical reason for expedited review" only when "Is this an expedited or urgent request?" is Yes, hidden by default.

4. Generate and review: Click Generate Rules. Review each rule AI previews, and approve, redo, or cancel as needed.

5. Save your logic: Once approved, make any manual adjustments, then click Save in the top right corner.

This workflow needs six emails: an internal alert to the coordination team on every new request, an internal documentation gap alert when the AI flags something missing, and four status updates to the patient and provider as a request is submitted, approved, denied, or appealed.

1. Open Custom Email Templates: Click your profile icon, go to Apps and Integrations, and find Custom Email Templates.

2. Add a new template: Click Add New Template, name it "New PA request received," and set the subject to New prior authorization request (PA-@rowid).

3. Generate the body with AI: Clear the body field, add an AI block, and paste this prompt: "Write a brief, factual internal notification telling the PA coordination team a new prior authorization request has come in for @patient_name, requesting @drug_requested from payer @payer_name. Include the reference number and prompt them to assign a coordinator and review the AI documentation readiness verdict. Under 3 sentences, no fluff. White background, single centered column max-width 560px, Inter or system-ui font, a compact data table showing reference number, patient, drug, and payer, muted footer in #999."

4. Repeat for the remaining five templates, using the same steps with these names, subjects, and prompts:

5. Save each template.

With the templates built, the next step is wiring up when each one fires, so patients, providers, and coordinators get the right update without anyone sending it by hand.

1. Open the On Submit logic tab: In Advanced logic, switch to the rule set that runs the moment a coordinator submits a new request.

2. Add the internal alert rule: On submit, send the "New PA request received" template to your PA coordination team's shared inbox.

3. Open the On Update logic tab: Switch to the rule set that runs when an existing record is updated. This is also what fires when the AI documentation analysis field writes its verdict onto the Documentation readiness field, since that update goes through the same record-update path as a manual edit.

4. Add the documentation gap rule: When Documentation readiness changes to "Documentation gaps found," send the "Documentation gap alert" template to @assigned_coordinator.

5. Add a rule per status change: Add four more rules, one per status: when Prior authorization status changes to Submitted to payer, send "Prior authorization submitted" to both @patient_email and @provider_email; when it changes to Approved, send "Prior authorization approved" to both; when it changes to Denied, send "Prior authorization denied" to both; when it changes to Appeal submitted, send "Appeal submitted" to both.

6. Save your logic.

Every request needs an internal record a coordinator or auditor can pull up later, one that includes the AI's documentation read alongside the clinical details it was based on. This is a self-contained HTML template Formaloo turns into a PDF for every row.

1. Open Custom PDF Template: Click your profile icon, go to Apps and Integrations, click Custom PDF Template, then Add New Template.

2. Switch to HTML view: Toggle the editor to HTML and paste the code below.

3. Name and save: Give it the name "Prior authorization case file" and click Save.

The reference number and submission date come straight from Formaloo's own variables, @rowid and @created_at, piped directly into the template text, no extra field required.

4. Attach it to a notification: Since this is an internal record rather than something sent to the patient or provider, attach it to the "New PA request received" email so the coordination team receives the full case file the moment a request comes in.

Your coordinators need their own pipeline, separate from the raw form, with each one able to find their assigned requests and any documentation gaps quickly.

Here's how the coordinator group of pages is laid out:

1. Start your project: Start from Form so your prior authorization intake form is already attached.

2. Add the "All requests" page: Add a Kanban page, point it at your intake form's data, and group it by Prior authorization status. Restrict its Access to Internal users → Specific teams, and select your PA coordinators team.

3. Add "My assigned requests": Add a table page filtered to Assigned coordinator = logged-in user, sorted newest first, with the same team-based access restriction.

4. Add "Documentation gaps queue," "Pending payer response," and "Denied, appeal needed": Duplicate "My assigned requests" three times and swap each filter for the one in the table above. All three inherit the same access restriction.

Clinical leadership doesn't need to read every case individually. This is where the AI documentation analysis you set up in Part 1, together with every request's outcome, rolls up into something they can actually use.

Here's how the leadership group of pages is laid out:

1. Add the "All requests overview" page: Add one more table page with no filter, showing every request regardless of status, and restrict its Access to Internal users → Specific teams, selecting your leadership group.

2. Add the "AI denial trend report" page: Add a new reference page and insert an AI Analyze block, pointing it at your intake form's data.

3. Prompt the report: Ask it to break down request volume and denial rate by payer and by drug class, surface the most common reasons requests were flagged with documentation gaps, and show the average time from submission to a final payer decision. Formaloo generates charts and a written summary from your live data.

A prior authorization workflow that starts checking its own paperwork the moment a coordinator hits submit. Every request arrives with an AI read on what that payer typically expects and what's actually missing, so nobody finds out about a documentation gap from a denial letter. Coordinators work from a pipeline that emails patients and providers automatically as a request moves through submission, approval, denial, or appeal, every request leaves behind a proper internal case file, and clinical leadership gets a live, AI-generated view of which payers and drug classes are driving denials, all without anyone building a tracking spreadsheet by hand.

Specialty pharmacy coordinators who've moved to a system like this typically describe the same shift: fewer requests bounce back from the payer for something that was missing from day one, because the gap gets caught and fixed before submission instead of after a denial letter arrives.

Don't build this from scratch, we've already put it together for you.