An outpatient request is a formal recommendation issued by a healthcare provider for services rendered for a person in a setting external from a hospital. Outpatient requests can be submitted prior to the service start date or retrospectively after the episode of care is completed.

This user guide details the steps to enter all information for an outpatient request so that it may be submitted for review. Refer to Reviewing a Request for the review and adjudication process.

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* Access to Utilization Management * Permission to create outpatient requests

When you have a request for outpatient services that needs to be reviewed for medical necessity and provider network requirements, either in advance or retrospectively.

* The Units Calculator is a time saver to help with calculating the correct number of units to be requested. Refer to [Using the Units Calculator](../using-the-units-calculator.md) for help and guidelines. * The outpatient request creation workflow can be started from the UM worklist. You will need to search for the person within the request.

Starting point is the CPV of the person for whom the outpatient request is being created.

Click **New Request**, and then select a **Request Category** from the menu.

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### Create Authorization Request - Requester Information* Select the **Request Source**. * _(Optional)_ Enter the **Requester Name**. * _(Optional)_ Select the **Requester Type**. * _(Optional)_ Enter contact information: phone, email, and/or fax.

### Create Authorization- Request Details* If this is an Authorization request, update the **Classification,** if needed.\ Classifications include the following:

**Request Classification - Some options may not be available to your organization.*** Prior Authorization: Request for approval before services are rendered. * Concurrent Review: Request for continued services during ongoing treatment. Commonly used for inpatient. * Post Service: Review request for services that have already been administered. Also known as retrospective review.

* Choose **Outpatient** as the **Request Type**. * Update the **Healthcare Type**, if needed. * Select a **Treatment Setting**. * Select an **Urgency**. * Update the **Notification Date/Time**, if needed. It is set to the current date and time by default.

Click **Create** to begin entering request details.

### Person InformationThe person's demographic and enrollment information is displayed. The individual's primary active enrollment is selected by default.To choose another enrollment, select the radio button for that enrollment.

### Provider InformationA servicing provider is required for an Outpatient request. Additional providers can be added to indicate their roles and involvement in this service.* Select the type of search to perform from the menu. Default is **Quick Search**. * Enter the search term. * Click +**Add** on the desired provider.

* Select at least one role for the provider. A provider may have multiple roles on the same request.

* To add more providers, enter a new search term and repeat the same steps. * To delete a provider, click **Remove**. * To add a temporary provider, click **Add Temporary Provider** and refer to [adding-a-new-provider.md](../../../platform-capabilities/adding-a-new-provider.md "mention").

Click **Continue**. Either the Custom Fields or Diagnosis and Services page displays.

### Custom FieldsIf your organization has custom fields configured, enter information into the custom fields, and then click **Continue** to move to the Diagnosis and Services page.

### DiagnosesA primary diagnosis is required for all requests. Multiple diagnoses can be added.* Enter the code or keywords for the diagnosis. * Click + **Add** on the desired diagnosis.

* To add more diagnoses, enter a new search term and repeat the same steps. * Click the

icon to indicate the primary diagnosis. * To delete a diagnosis, click the

icon.

### ServicesA primary service is required for all outpatient requests. Outpatient services can have different durations and dates.* Enter the code or keywords for the service. * Click **+Add** on the desired service.

* _(Optional)_ Enter CPT Code **Modifiers**, if needed. * Enter the expected **Duration** of this service and select the timeframe unit of measure (e.g. Weeks) from menu. * Manually enter the **From Date** or select from the calendar picker.

The **Through Date** automatically calculates based on the entered duration, units, and from date. Changing any of these adjusts the through date.

* Select the **Review Type.** * Enter the requested number of **Units** to be provided within this request and select a unit of measure. * Select the **Treatment Type**. * _(Optional)_ Select the **Place of Service**. * To add more services, enter a new search term and repeat the same steps. * Click the

icon to indicate the primary service. * To delete a service, click the

icon.

Click **Continue** to move to the **Attachments** page**.**

### Attachments (Optional)You can add supporting documents to the created request. Refer to [#adding-a-file-type-attachment](../management/managing-request-attachments.md#adding-a-file-type-attachment "mention")for more information.

Click **Continue** to go to the Review page.

### Review and SubmitReview all details of the request prior to submitting it for review. If you need to make changes, click the

icon to be navigated directly to that section.* Click **Submit** to finalize the information entered. * (_Alternate)_ Click **Delete Draft** to return to the CPV without saving the outpatient request.

### Request SubmittedAfter successful submission of the outpatient request for review, a summary dialog box displays. The automated outcome, if any, is provided.

Click either **View Request** to view the request or **Back to CPV** to go back to the person's CPV.

If your workflow started from the worklist, the options will be **Back to Worklist** or **View Request**.