Registration Authorizations Tab

The Authorizations tab is used to review and authorize coverage for charges on visits that have an insurance that requires service authorizations, allowing those charges to be included on the insurance claim and for Billing to process the visits. An authorization provides coverage for a defined date range and can cover all charges within a range of days or a specified number of encounters (charge dates or units) within that date span.

Multiple authorizations can be added as long as they use the same U/R method and their date ranges do not overlap or have gaps. Once an authorization is added, charges are then matched to it based on the date span, then units used are counted and compared with the authorization allowance.

An authorization must have a status of Approved in order to be processed by Billing. Billing will then process the visit, creating insurance claims for authorized charges and splitting billing events for separate authorized claims when necessary based on authorization dates. If the authorizations overlap or have gaps, a billing exception will be created. Keep in mind that authorizations for inpatient visits do not need to include the day of discharge, so a visit with charges on its discharge date will bill successfully even if its authorization ends the day before the discharge date.

To add an authorization, follow these steps:

1. Click the Add  button. A row is added to the list, and the Insurance and Managed Care ID fields are enabled.
2. Insurance – Click the dropdown menu and select the insurance. The menu includes all insurances that are associated with the visit.
3. Managed Care ID – Enter a managed care code in the first field or a managed care organization in the autocomplete field (clicking a suggested description to select it).  The remaining fields are enabled.
4. Authorization No – Enter the alphanumeric authorization number provided by the insurance company.
5. Status – Click the dropdown and select a status. The authorization must have a status of Approved in order to be processed by Billing. The other options (Appealed, Denied, and Doctor Review) are informational for utilization reviewers.
6. Approved From/Approved To – Click the field to enter the date directly or click to select a date from a calendar. The Units Auth field on the Authorization Detail tab is automatically calculated. A date range is required for all U/R methods.

7. Select at least a UR Method on the Authorization Detail child tab.

8. Click Save.

Update Authorization

To update authorization information, follow these steps:

1. Click on an authorization in the Authorizations list to select it.
2. Make any necessary changes.
3. Click Save.

Delete Authorization

To delete and authorization, follow these steps:

1. Click on an authorization in the Authorizations list to select it.
2. Click the Delete  button. The authorization is removed from the list.
3. Click Save.

Authorization Detail

The Authorization Detail tab is used to choose the UR (utilization review) and complete approval and certifier information for the selected authorization.

1. U/R Method – Click the drop-down menu and select the method:
   • Date Range – Authorizes charges for a defined date range, with each authorized day serving as an authorized unit. Calculates the Units Used by counting days (units) between the authorization To and From dates and compares that to the authorized units.
   • Encounter – Authorizes a specific number of charge dates (entered in the Units Auth field) for a defined date range. Calculates the Units Used by counting charge dates and compares that to the authorized units. This accounts for all charges on that date.

2. Man. Care Ph – Displays any phone number associated with the selected Managed Care ID on the Authorizations tab.
3. Units Auth – Enter the number of units authorized for encounter authorizations. This field is disabled for date range authorizations.
4. Next Callback Date – Click the field to enter the date directly or click to select a date from a calendar. This field is used if another approval is required for a service after a pre-determined time frame.
5. Approval Cd – Enter the alphanumeric approval code.
6. Certifier – Click the drop-down menu and select the person who certified the insurance.
7. Grace Days – Enter the number of days allowed before utilization review information must be updated.
8. Reviewed By – Defaults to the user creating the authorization. To change the reviewer, enter a valid RCM Cloud^® user ID.
9. Reference No – Enter an alphanumeric reference number.

10. Click Save.

Add Certifier

The Certifier Entry window is used to add an insurance certifier on the fly from the Authorization Detail tab. Once added here, the new certifier is added to the Certifier drop-down menu on the Authorization Detail tab and is added to the system.

Certifiers are contact people at an insurance company who verify that a patient is qualified to receive care from the facility based on their insurance. They are the primary contacts when performing an insurance utlization review.

To add a certifier, follow these steps:

1. Click the Add Cert button. The Certifier Entry window displays.

2. Last Name, First Name, and MI – Enter the certifier’s name information.
3. Phone – Enter the certifier’s phone number.

4. Click Save. The new certifier is selected by default on the Authorization Detail tab.