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:
To update authorization information, follow these steps:
To delete and authorization, follow these steps:
The Authorization Detail tab is used to choose the UR (utilization review) and complete approval and certifier information for the selected authorization.
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: