Managing Care Approvals with the Archimedes Prior Authorization Form

In healthcare, speed and accuracy can make the difference between timely patient care and frustrating delays. The Archimedes prior authorization form plays a key role in making sure patients receive necessary medical services while providers get reimbursed promptly.

For medical offices, understanding exactly when and how to use this form is critical. This article walks you through what the form is, why it matters, how to complete it accurately, common mistakes to avoid, and best practices for getting approvals without delay. You’ll also learn how virtual assistants can streamline this process for your team.

The Role of Prior Authorization in Patient Care

Why It’s Needed in Modern Healthcare

Prior authorization is a review process used by insurance companies to determine whether a proposed medical service, medication, or procedure is medically necessary and covered under a patient’s plan.

It ensures:

• Services are clinically appropriate

• Costs are managed effectively

• Patients receive the right care at the right time

The Archimedes Approach to Service Approvals

Archimedes Health Plan uses prior authorization to maintain care quality and control costs. Their criteria are based on evidence-based guidelines, medical necessity, and plan coverage specifics.

Impact on Patients and Providers

When done right, prior authorization protects patients from unexpected bills and helps providers maintain compliance with payer requirements. When done wrong—or skipped altogether—it can lead to claim denials, rescheduling, and care disruptions.

For strategies to prevent administrative bottlenecks, see How to Achieve Efficient Back Office Operations.

Overview of the Archimedes Prior Authorization Form

Purpose and Function

The Archimedes prior authorization form is the official request document for approval before providing certain services. It captures all the information needed for review, including patient details, provider credentials, procedure codes, and supporting documentation.

Services That Require It

Typical services that require prior authorization from Archimedes include:

• Advanced imaging (MRI, CT, PET scans)

• Elective surgeries

• Specialty prescription drugs

• Home health services

• Durable medical equipment (DME)

Who Is Responsible for Submission

Generally, the provider’s office—often a medical assistant, nurse, or billing staff—handles the form submission. Patients may need to provide additional records or insurance details to complete the process.

How to Access the Archimedes Form

Provider Portal Access

The Archimedes provider portal offers the fastest and most secure way to access and submit the prior authorization form. Benefits include:

• Online completion and submission

• Secure document upload

• Instant confirmation numbers for tracking

Downloadable PDF Format

For offices without portal access, Archimedes provides PDF forms that can be filled out and submitted via fax or secure email.

Requesting by Phone or Email

Provider services can send the form directly upon request. This option is helpful for urgent cases where a quick start is needed.

Maintaining a digital library of the latest forms can save time—see The Power of a Virtual Talent Team for tips.

Detailed Instructions for Completing the Form

Patient Information Section

Include:

• Full legal name

• Date of birth

• Archimedes member ID number

• Contact details

Provider Information Section

Provide:

• Provider name and specialty

• NPI and tax ID numbers

• Practice address and contact information

Procedure, Diagnosis, and Service Codes

Use the correct CPT/HCPCS procedure codes and ICD-10 diagnosis codes. Incorrect codes are a top cause of denials.

Required Supporting Documentation

Attach:

• Recent clinical notes

• Imaging or lab results

• Previous treatment records, if applicable

For accuracy, create a submission checklist—Why Every Business Needs Standard Operating Procedures explains how to standardize workflows effectively.

Common Mistakes to Avoid with Archimedes Authorizations

Missing Details

Omitting even minor fields—like a provider NPI—can cause delays or rejections.

Incorrect Coding

A single wrong code can invalidate the request. Always double-check CPT, HCPCS, and ICD-10 codes.

Insufficient Documentation

If medical necessity isn’t clear from the documentation, Archimedes is likely to deny the request.

Pre-Submission Checklist and Workflow Optimization for Archimedes Authorizations

Submitting a prior authorization request to Archimedes Health is not just about filling out a form—it’s about making sure every piece of the puzzle is in place before the request hits the insurer’s review desk. A well-prepared submission increases the chance of approval, shortens processing time, and reduces the need for back-and-forth communication.

Here’s a detailed checklist and workflow model to help providers and administrative teams get it right the first time.

Step 1: Confirm Prior Authorization Requirements

Before you gather a single document, confirm whether the requested service or medication actually requires prior authorization under the patient’s Archimedes plan. This step can prevent unnecessary work. Use:

• The Archimedes provider portal

• The current prior authorization list for the plan type

• Provider relations support lines

Pro tip: Policies change. Always check the latest requirements before assuming that a service doesn’t need pre-approval.

Step 2: Gather Complete Patient Demographics

Missing patient details can cause immediate rejections. Ensure you have:

• Full legal name (matching insurance records)

• Date of birth

• Archimedes member ID

• Current address and phone number

• Primary and secondary insurance info (if applicable)

Step 3: Verify Provider Eligibility and Network Status

Even a perfectly documented request can be denied if the provider is out-of-network. Confirm:

• NPI and tax ID are active and correct

• Provider is listed in Archimedes’ network directory

• Any referring or rendering provider details are included if required

Step 4: Accurately Code the Request

Use the correct CPT/HCPCS procedure codes for the service and ICD-10 diagnosis codes for the medical condition. Double-check:

• Code specificity (avoid unspecified diagnosis codes)

• Alignment between diagnosis and procedure codes

• Modifiers if necessary (e.g., bilateral procedures)

Step 5: Include Strong Medical Necessity Documentation

Medical necessity is the backbone of approval decisions. Attach:

• Recent clinical notes detailing symptoms and history

• Results from tests, imaging, or labs that justify the request

• Documentation of prior treatments attempted and their outcomes

• Specialist consultation reports (if applicable)

Step 6: Organize Documentation Clearly

A jumbled pile of attachments can slow down the review process. Organize documents with clear labels, such as:

• “Clinical Notes – 05/10/2025”

• “MRI Results – 04/28/2025”

• “Previous Treatment Summary”

Step 7: Choose the Fastest Submission Method

Whenever possible, submit via the Archimedes provider portal. It:

• Provides instant confirmation numbers

• Reduces the risk of lost faxes or delayed emails

• Allows for secure document uploads

Fax should be a backup method, not the primary choice—unless portal access is unavailable.

Step 8: Track and Follow Up

A submission is not the end of the process—it’s the midpoint. Maintain an authorization tracking log that includes:

• Date of submission

• Method of submission

• Confirmation/tracking number

• Expected decision date

• Follow-up dates and contact notes

This proactive tracking ensures no request “slips through the cracks.”

Step 9: Assign Responsibility Within Your Team

Designate specific roles:

• Preparer: Gathers documentation and codes the request

• Submitter: Completes and sends the form

• Tracker: Monitors status and follows up

This prevents confusion and ensures accountability.

Step 10: Perform a Pre-Submission Quality Check

Before hitting “submit,” quickly verify:

• All required fields are completed

• All supporting documentation is attached

• Patient and provider IDs match insurance records

• Codes are accurate and consistent

Implementing this pre-submission checklist does more than reduce denials—it builds a consistent, repeatable process that can scale across multiple providers or locations. If your team struggles to keep up with prior authorization volume, consider leveraging a virtual assistant or an AI-augmented back-office team like OpsArmy to handle the repetitive, detail-heavy parts of the workflow.

For guidance on delegating these responsibilities efficiently, see The Power of a Virtual Talent Team.

Timelines for Review and Approval

Standard Processing Times

Routine requests are typically reviewed within 5–10 business days.

Expedited Requests

For urgent cases, Archimedes may process within 72 hours if medical urgency is documented.

How to Track Request Status

Use the provider portal or call provider services to monitor progress. Keeping a prior authorization log is essential for follow-up.

For tracking tools, see Top 10 Tech Tools for Back Office Teams.

How Virtual Assistants Support Prior Authorization Workflows

Gathering and Preparing Documentation

VAs can collect patient demographics, insurance details, and clinical records before provider review.

Submitting and Tracking Requests

Once submitted, they can track the status daily, ensuring timely responses to insurer inquiries.

Managing Renewals and Expirations

Prior authorizations often expire—VAs can set reminders to renew requests before deadlines.

Learn how to delegate effectively in How to Make Over Your Back Office.

Troubleshooting Delayed Requests

Checking Submission Status

If the review takes longer than expected, confirm that Archimedes received the request and that all required documents are on file.

Responding to Additional Information Requests

Sometimes the UM (Utilization Management) team will request extra records. Responding promptly can prevent further delays.

Escalating Urgent Cases

Contact your provider relations representative if the delay is critical. They can escalate internally.

Key Roles in the Archimedes Prior Authorization Process

Ordering Provider

Determines the necessity of the service and provides key clinical details.

Administrative Staff

Handles the actual form completion, submission, and tracking.

Utilization Management Team

Evaluates requests based on policy and medical guidelines.

Patient or Caregiver

May supply historical records or follow up on requests.

Clearly defining roles helps avoid confusion and lost time.

Best Practices for Smooth Approval with Archimedes

Verifying Requirements Before Submission

Check the latest Archimedes authorization list to ensure the request is needed.

Maintaining an Authorization Log

Track submission dates, status updates, and expiration dates.

Staying Informed on Policy Updates

Archimedes policies can change—review them regularly to avoid surprises.

Common Reasons Archimedes Denies Requests

Missing or Incomplete Information

Simple omissions—like forgetting a CPT code—can lead to denial.

Lack of Medical Necessity

If documentation doesn’t support the request, approval is unlikely.

Out-of-Network Services

If the provider is not in the Archimedes network, coverage may be denied or limited.

For more tips, see Work Smart: AI and Virtual Talent for Business Success.

Final Thoughts: Building a Reliable Prior Authorization Process

The Archimedes prior authorization form is more than a box to check—it’s a crucial step for securing coverage and protecting patient care. By following best practices, avoiding common mistakes, and leveraging virtual assistance, providers can streamline this process and focus on delivering quality care.

About OpsArmy

OpsArmy is building AI-native back office operations as a service (OaaS). We help businesses run their day-to-day operations with AI-augmented teams, delivering outcomes across sales, admin, finance, and hiring. In a world where every team is expected to do more with less, OpsArmy provides fully managed “Ops Pods” that blend deep knowledge experts, structured playbooks, and AI copilots. Think of us as your operational infrastructure: running faster, leaner, and smarter business execution. Visit https://www.operationsarmy.com to learn more.

Sources

• Archimedes prior authorization form – https://archimedesrx.com/resources/

• Centers for Medicare & Medicaid Services – cms.gov

• National Association of Insurance Commissioners – naic.org