This template is part of the prior authorization follow-up guide. Copy the blank, fill it in during one conversation with the director, then compare it with the completed example below.
The blank brief
Copy this table into an email or document. Every row describes metadata: what exists, how much, how long, where and who.
| Field | What to write | Never include |
|---|---|---|
| Company | Full-time headcount at peak, role (provider group or revenue cycle company), country | Client or patient names |
| Business task | One line on the follow-up work: pend received, document found, resubmitted, decision chased | Any individual request |
| Record classes | Which kinds exist: each request as sent and resent, payer asks for more paperwork, decisions with reasons, internal task notes, a log of what each payer requires | The records themselves |
| Systems | Software names or types, plus any fax server or electronic transaction vendor; flag the one being replaced | Logins, exports, screenshots |
| Years and volume | Years of closed requests per system; approximate pended requests per year | Patient counts by payer or service |
| Record owner | The role that manages the history day to day | Personal contact details beyond the work email |
| Decision-maker | The executive who can approve a data discussion, plus the privacy officer | Opinions on value or price |
| Access event | Date old platform access ends, or "not set" | Vendor contract terms |
| Open question | One general question about whether the evidence chain survives | A specific case |
Filling it in with the revenue cycle director
Most rows take one question each. A few need care.
Company. Count full-time employees at peak and leave contractors out; offshore authorization teams staffed by a vendor do not count toward the 50.
Record classes. Ask which kinds exist, not which are complete. A director may know that resent requests are kept but not whether every attachment travelled with them. Write what is known and mark the rest unconfirmed.
Systems. Name each tool once. Electronic requests follow the HIPAA standard transaction for prior authorization, so an outside transaction vendor may be involved; list it separately, because its retention follows its own contract, not the company's.
Years and volume. Separate the current platform from anything already retired. A director often knows the live system's depth but forgets the history sitting in a system switched off years ago, which may still be readable.
Role. For a billing company, add how many provider clients the history covers. HHS guidance says a business associate may use or disclose protected health information only as permitted or required by its business associate contract or as required by law, so the count tells the decision-maker how much agreement review lies ahead.
Decision-maker. If the director hesitates, the who-can-license decision tree walks through who can say yes.
Open question. Phrase it about the chain, not a patient. A useful one: when a payer changed a requirement after the first submission, does the record keep the link between version one, the pend and version two?
Completed brief (Illustrative)
Illustrative only. The company and every figure are fictional.
| Field | Entry |
|---|---|
| Company | 230 full-time employees at peak; multi-specialty provider group running its own authorizations; U.S. |
| Business task | Chasing pended imaging and surgical authorizations from pend to payer decision |
| Record classes | Request versions with attachments, payer document requests, decisions with reasons, payer requirement log |
| Systems | Practice management system with authorization module; fax server; electronic transactions through a clearinghouse |
| Years and volume | Nine years in the current system, two more in a retired one; roughly 14,000 pended requests a year |
| Record owner | Authorization supervisor, reporting to the director of patient access |
| Decision-maker | Chief operating officer, with the privacy officer; director of patient access as sponsor |
| Access event | Not set; the practice management vendor contract renews in 2027 |
| Open question | When a payer asked for a new document after the first request, can the reply be tied back to the original request? |
| Not shared | No patient, member, payer contract or clinical detail; no exports or logins |
Notice what the example does not say: nothing about price, nothing about what an AI lab might want, nothing about any patient. It gives the chief operating officer enough to decide whether a conversation is worth an hour.
Covering note and what happens next
Two or three sentences are enough above the table: who you are, why the access date matters, and that the company keeps control of every record. The warm introduction brief and warm introduction etiquette cover tone, and the client opportunity brief generator can draft a first version.
After the executive reads it, SourceX reviews qualification, rights and de-identification. As they stand the records are protected health information, so any licensed version would need to meet HIPAA's de-identification standard by Expert Determination or Safe Harbor. SourceX licenses approved business data directly from companies for AI training and evaluation, and manages the agreement, rights review, data preparation, delivery and payout. Buyer interest, the rights result and any offer stay unknown until that review. The systems map for this workflow helps if the director wants to check which identifiers join the records first.
For SourceX, an introduced company needs 50+ full-time employees at peak (contractors excluded), a documented operating history, rights to license and an authorized contact. Companies in the U.S., Canada and the EU qualify, as do companies in the UK, Australia, New Zealand, India, Singapore, South Africa, Latin America, the UAE and Saudi Arabia when at least 90% of the data is in English. Partners sign the Channel Partner Agreement before submitting introductions; the first valid introduction within the 90-day window is credited when the company submits a verified application. Sector context sits under revenue cycle management firms and healthcare operations.
Next step
Refer a company. Earn up to $100,000. Default reward: 25% of Actual Supplier Payout, capped at $100,000 cumulatively per referred company. Eligibility and payment conditions apply, and a signed Schedule A or addendum can differ. A lead, meeting or signature alone does not trigger payment.
With every row of the brief filled in or honestly marked unknown, register as a partner, confirm the company on who qualifies and read the program terms before the director forwards it.