Authorizations are used in the case that a specific payer is requesting a Pre-Authorization for services rendered. This article will walk you through setting up authorized insurances, defining any procedures that are excluded when an authorized service/unit is required, setting up authorization alerts, and setting up authorizations per patient.
Set Up Authorized Insurances
Follow the steps below to set up insurances that are given authorization to cover services/units.
Access Level Permission to Administration > Insurance needed.
- Go to Administration > Insurances.
- Use the search box to find the insurance you wish to classify as an authorized insurance.
- If you are creating a new insurance, refer to the Insurances Setup article for details.
- Once you select the desired insurance, click the Insurance Options tab.
- Check the box for Authorization Alert to send an alert if the insurance requires an authorized service/unit.
- Check the box for Authorization Required to require an authorization when billing with this insurance.
- Click Save.
- Repeat these steps for any insurance you wish to classify as an authorized insurance.
Set Up Authorized Procedures
Follow the steps below to define any procedures that when an insurance is requiring an authorized service/unit is excluded and set up procedures to require authorization from an insurance company.
Access Level Permission to Administration > Procedures needed.
- Go to Administration > Procedures.
- Use the search box to find the procedure you wish to modify.
- If you are creating a new insurance, refer to the Add or Edit a Procedure article for details.
- Once you select the desired procedure, click the Once you select the desired procedure, select the first Procedure Info tab.
- Check the box for Auth Alert to indicate that this procedure requires an authorized insurance.
- Check the box for Do Not Use Auth so that when an insurance company requires authorized services/units this procedure is excluded.
- Click Save.
- Repeat these steps for any procedures you wish to modify.
Set Up Authorization Alerts
Follow the steps below to set up alerts for authorizations. There are options to send an alert based on uses/units left and to send an alert a designated number of days before an authorization expires.
Access Level Permission to Setup > Options needed.
- Go to Setup > Clinic Options > Alerts tab.
- Define Authorizations alerts based on uses/units left and days prior to renewal date.
- Check the box for Send Auth Alert When Number of Uses Left is to send an alert when the number of authorized uses left is “x”, as defined in Patient Details.
- Check the box for Send Auth Alert When Number of Units Left is send an alert when the number of authorized units left is “x”, as defined in Patient Details.
- Check the box for Alert Primary User to send the alert to the primary user.
- Select an Alert Group from the drop-down menu to send the alert to the selected alert group.
- Check the box for Send Auth Alert Prior to Number of days to send an alert “x” days before the next review date is set to occur, as defined in Patient Details.
- Check the box for Alert Primary User to send the alert to the primary user.
- Select an Alert Group from the drop-down menu to send the alert to the selected alert group.
- Click Save.
Set Up Authorizations Per Patient
IMPORTANT: For any new or current authorizations, you must flag the Prior Authorization box. This will send the qualifier as G1, not 9F, on the 837. Follow the steps below to set up authorized insurances for a patient.
Access Level Permission to Patient Details > Authorizations tab needed.
- Navigate to Patient Details for the desired patient, one of three ways:
- Go to Day to Day > Patient Details > search for the patient.
- My Client List > right-click on the specific patient’s name > select Patient Details.
- Click the patient’s name link in the top left corner of their chart.
- Go to Day to Day > Patient Details > search for the patient.
- Once Patient Details is open for the patient, select the Authorization tab.
- In the Authorization tab:
- Select the Insurance that has been given authorization to cover services/units.
- Enter the Authorization Number for the authorized insurance that was provided by the insurance company.
- In the Start Date tab:
- Select the Start Date provided by the insurance company that the authorizations will begin.
- Select the End Date provided by the insurance company that the authorizations will end.
- Select a Next Review Date on which you will review if another authorization is required.
- Under Decrement By, select how the authorizations are to be used. This is determined by the insurance.
- Select Services to decrement by services.
- In the Uses/Uses Left field, enter the number of authorized Uses, provided by the insurance company, remaining during the authorization period. These numbers should always match.
- In the Uses/Uses Left field, enter the number of authorized Uses, provided by the insurance company, remaining during the authorization period. These numbers should always match.
- Select Units to decrement by units.
- In the Units/Units Left field, enter the number of authorized Units, provided by the insurance company, remaining during the authorization period. These numbers should always match.
- In the Units/Units Left field, enter the number of authorized Units, provided by the insurance company, remaining during the authorization period. These numbers should always match.
- Select Units w/ Proc to decrement by units with procedures.
- In the Diagnoses and Procedures tabs, enter the specific diagnoses and procedures that are authorized during the authorization period. Only these diagnoses/procedures will be covered.
- In the Diagnoses and Procedures tabs, enter the specific diagnoses and procedures that are authorized during the authorization period. Only these diagnoses/procedures will be covered.
- Select Services to decrement by services.
- Check the box for Prior Authorizations to send the qualifier on the 837 as G1 rather than 9F.
- Click Update Authorizations List to create the new authorization.
- Your authorization will now appear in the Authorizations table below.
- Click Save to save any authorizations you have created for the patient.
- Repeat the steps above for each patient and each authorization per patient.