PERMISSIONS REQUIRED: You need the Scheduling, Billing, or Admin permission to manage a patient's authorizations.
Go to the payer in a patient’s information to manage the authorizations you've received from their payer. See Working in the Patient Chart for more information.
When charges are submitted for a patient with a date, service type, and billing code that matches an authorization, the visits or units will be deducted and the authorization number will appear on the claim.
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Add an Authorization
- Click the + Authorization button.
- Enter the Number: This is the Prior Authorization Number provided to you by the payer. This will appear on claims that meet the tracks in field 23.
- Enter From/To dates: This is the date range this authorization is valid between.
- Enter Notes: Any notes about the transaction. It may be helpful to use this space to enter things like Starting Authorization Number or Call Reference Numbers from the payer.
- Click the Tracks tab.
- In the Services section, check the box next to any services that this authorization needs to apply to, or leave all boxes unchecked to indicate all services.
- In the Units section, enter the number of visits this authorization was approved for, or leave blank to indicate authorization for unlimited visits.
- In the Codes section, enter the billing codes that this authorization applies to.
IMPORTANT: Only Enter codes if the payer specified specific codes. Ensure the Codes are entered in a "Code, Code" format; the system will not recognize any other format.
- In the Reminders section, select how reminders will be triggered.
- Click the +Track button to add an additional Track.
- When you are finished, click the Save Authorization button.
NOTE: Authorizations are not retroactive. If this patient has previously been seen prior to entering the authorization, you will need to deduct any visit/units that have already been completed.
Edit an Authorization
- Click the authorization you want to edit.
- Once you've made changes, click the Save Authorization button.
Re-order Authorizations
The order of a patient's authorizations determine which of them have active reminders.
- The green bell icon
indicates the authorization's reminders are turned on.
- The red bell icon
indicates the authorization's reminders are turned off.
If two authorizations have the same billing codes and services, the authorization at the top will turn off the reminder below it. However, if the codes or services are different, the reminders for both will be active.
To re-order authorizations:
- To the left of an authorization, click and hold the move handle.
- Drag the authorization to a new position and let go.
Delete an Authorization
If you accidentally created an authorization or you don't want to keep an old authorization on file, you can delete it from the patient.
- To the right of the authorization, click the delete icon.
- Click the Delete Authorization button.
About the Fields
| Field | Description |
| Number | The authorization number provided by the payer, which will appear on the claims it applies to. |
| From / To | The effective date range of the authorization. Leave this blank if it should apply to any date. |
| Notes | This can be used to record notes about the authorization for your reference. |
| Services | The service types the authorization track applies to. Leave this blank if it should apply to all service types. |
| Visits / Units | The number of visits or units allowed by the authorization track. You can change whether authorizations count by visits or units on the payer. |
| Codes | A comma-separated list of the billing codes this authorization track applies to. Leave this blank if it should apply to all billing codes. |
| Reminders | Determines whether reminders for the authorization track are controlled automatically (recommended) or manually. |
| Threshold | Determines when unit-based authorization reminders will appear for this authorization. Leave this blank to use the global reminder settings in Clinic Options. |