Required fields are marked with a red asterisk (*).  Start by entering a unique description for the authorization.  This should be a description that uniquely identifies an authorization for a particular client.  This makes it easier to locate a particular authorization, particularly when navigating from the search grid.  After selecting the client, the record number populates.  This is pulling from the client code field in the client record.  This can be over-written if it is not the correct record number to go on the claim.  This field also populates to the header of the note forms.

 

 

 

 

Select the Authorizing Payer from the drop-down.  This is the entity that approved the authorization.  Next, enter the authorization number if it is required by the respective payer to go out on the claim. 

 

 

 

 

 

Select the Approved checkbox to mark the authorization as approved.  If the authorization is not marked as approved, the system will automatically hold-bill any time records associated with the authorization.  Once an authorization is marked as approved, any time records that had been placed on hold bill will be automatically taken off of hold bill.  This is a nice workflow that allows schedules and notes to be entered if services are still going to be rendered, but prevents the billing from going out until the authorization is approved and in hand.

 

 

 

 

 

 

Enter the start and end dates for the authorization.  Notice the dates are automatically pulled forward to the Services section of the authorization.

 

 

 

 

 

 

The Authorization Level Validation checkbox should be selected only when it is required to enforce unit maximums for all services associated with the authorization.  This is especially useful for bundled services where the system should validate unit maximums for combined totals across all bundled services that were authorized as a package with one set of units.

 

 

 

 

Complete the authorization by entering the service information on the lower pane of the window.  Select the service from the Service drop-down (this is a listing of all services that the agency is contracted to provide with the selected authorizing payer).  Next, select the Funding Source; this is pulling from the client record.  In the absence of a funding source to select, go back to the client record and add under the Insurance tab.  The Service Location indicates where the service was provided and is the billing location code submitted on the claim.

 

 

 

 

Adjust the start and end dates if necessary (usually only when there are varying units over different segments of time within the authorization period). For example, when a plan is written that dictates the number of units that can be provided during school weeks vs non-school weeks and those are different amounts, then the system can ensure compliance within those unit parameters when the service start/end dates are representative of school and non-school periods.  Next, select the Site.  This needs to reflect where the service was provided.  This typically should be a match to the authorization request but ultimately it is the physical location of where services will be rendered.

 

 

 

 

Cost center is optional but important if the revenue from the authorized service is to be allocated to a cost center other than the client’s home cost center.  In the absence of a cost center selection here, the system will report the revenue for the service to the client’s home cost center, found on the Identification tab of the client record.

 

 

 

 

The DSM5 pulls from the respective tab of the client record.  While this is not a required selection on the auth, the diagnosis is a required element of the claim. It is good practice to open this drop-down and ensure one is entered.  In the event the client is dually diagnosed and receiving services from multiple programs, it will be important to select the diagnosis that supports the service in order for successful payment of claims.

 

 

The client specific unit rate is used to override the standard reimbursement rate set for the service and payer.  Any value entered here would automatically pull to the claim.  In the absence of a rate here, the system pulls from the service record for the authorized payer. 

 

The billing/attending field represents the NPI’s that will get submitted on the claim based on the authorizing payer, service and site selections on this authorization.

 

Enforce Employee/Client Validations is a checkbox used to enforce a system rule that looks to see if the client is assigned to the employees roster on the Roster tab of the employee profile.  If not, then a warning message is thrown indicating the employee/client relationship is not a valid working one.  This is most beneficial at the scheduler, in order to prevent a bad pairing that would prohibit compliant service delivery.

 

 

 

 

The units are critical for management of service delivery.  There are reporting capabilities to understand authorization utilization, helping you to achieve and manage all authorized potential revenue.  Likewise, if schedules, notes or billing records exceed the authorized unit amount system notifications are thrown and securities control how these messages are handled.  This is very core functionality with lots of added value.  Enter in units for each time constraint to be managed.  Each parameter operates off of the calendar, meaning the week parameter is Sunday to Saturday, the month is calendar month, etc.

 

Be sure to save the authorization.

 

 

 

 

If additional services need to be added to the authorization, click on the Add Service button.  This will refresh the service fields for entry of a new service.  Add as many services to the authorization as are required by clicking on the Add Service button and entering the service specific information.  Click Save after adding each additional service. 

 

 

 

 

An alternate method of service entry is through the use of Authorization Templates.  Authorization Templates are a means of pulling multiple services into an authorization all at once.  In order to use an Authorization Template, click on the Use Template button. 

 

 

 

 

This brings up a service details window.  Once you enter the required information here and click on the Save button, all of the services associated with the template will be pulled into the authorization.  Templates are configured by clicking on the Authorization Templates button.