← All glossary termsExplainable Prior Authorization
A prior auth decision (approval, denial, or pend) accompanied by a clear, traceable rationale tied to the specific payer policy or clinical criteria applied.
What it means
Explainability turns a decision into something a human can review and defend, rather than a result that has to be trusted blindly. This matters most when a request is denied or pended — providers and patients need to understand exactly what criteria weren't met, not just that something failed. It's the practical, patient-facing expression of auditable automation.
