An SR authorization request summary includes the following parts:

Member ID includes the member identification number, member name, date of birth/age, and gender.

Authorization Details show all the data entered for the authorization request, such as the request's start date (earliest start date), end date (latest end date), and closed date, and the service provider's name, NPI, specialties, and address. Fields without data indicate that the entry was optional and the user chose not to exercise the option.

Line Item Details includes line item number, service code/description, modifier code, service offer, service location, quantity, start date, end date, determination status, and applied eligibility. Rate information is included if configured by your organization.