Adding a Referral to a Charge

Referral Authorizations must be attached to charge tickets for billing and to print on the HCFA claim forms.  There are three methods for adding a Referral Authorization to a charge:  the Charge Entry Manual Method, the Charge Entry Automated Method, and the Informational Only Method.

Tips:  

• All methods enable the Referral Authorization Number to print in Box 23 of HCFA claim forms or the electronic equivalent.

• Do not confuse attaching a referral to a charge and having the Authorization Number print in box 23 of HCFA claim forms with printing a referring provider UPIN in box 17 of HCFA claim forms.  They are separate functions.  The directions below describe how to attach a referral to a charge.  For directions on printing a referring provider UPIN, see Printing a Referring Provider UPIN on HCFA Claim Forms.

• The following programs control referral authorization:

• Charge Entry Preferences Maintenance:  To set up Charge Entry to automatically attach referrals to charges, set the Pull Ref. Auth. Data option default to Yes.

• INSight .MCPARAM Record

• Insurance Addendum Maintenance:  The Referral Authorization Active Option must be Y(es).

Procedures:

To see the procedure for using the...

• Charge Entry Manual Method, click More.

   

  Tips:

  • When third-party claim forms are generated, the Authorization Number will print in the box 23 of HCFA claim forms or the electronic equivalent.

  • You can use this method to maintain the referral's Remaining Visits field.

  Directions:

  To manually attach a referral to a charge during Charge Entry:

  1. Create a referral for the patient during Patient Entry at the Referral Authorization Window.

  2. Enter a patient charge during Charge Entry:

  1. At the Batch Entry Window, specify N(o) for the Pull Ref. Auth. Data option.

  2. Enter charge transactions and click End Charges at the Charge Entry - Transaction Detail Area.

  3. At the Commit Charges Window, set the Prior Authorization field to Yes.

  3. After you click Commit, the Prior Authorization Maintenance launches.  Attach a referral authorization...

  1. Enter the Patient Account Number and click Load.

  2. To highlight the desired ticket, click the appropriate ticket in the Patient Ticket Display Area.  The ticket information displays above the search list for your reference.

  3. To attach a referral authorization, enter a valid Authorization Number or to search for the Authorization Number, click Search .  Double-click a Referral Authorization to select it.

  4. To attach the Authorization Number, click Update Referral Info.
     Note:  To avoid losing your data, you must click Update Referral Info.

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• Charge Entry Automated Method, click More.

   

  Tip:  You can use this method to automatically update the referral's Remaining Visits and Remaining Amount fields, if you use superbills.

  Directions

  To automatically attach a referral to a charge during Charge Entry:

  1. Create a referral for the patient during Patient Entry at the Referral Authorization Window.

  2. Print an encounter form (superbill) for the patient.
     Note:  The Referral Authorization Number must be attached to the superbill.

  3. Enter a patient charge during Charge Entry:

  1. At the Batch Entry Window, specify Y(es) for the Pull Ref. Auth. Data option.

  2. At the Charge Entry - Location & Provider Area, enter the Encounter Number for the superbill.  The referral information is automatically pulled in.  When you tab out of the field, Charge Entry automatically updates the Referral Source, Cause, Cause Date, and Insurance Code with the referral data.

  3. Enter the charge transactions and click End Charges at the Charge Entry - Transaction Detail Area.

  4. At the Commit Charges Window, you will see the Authorization Number.  Click Commit.

  4. After you click Commit, the Referral Authorization Window launches.

  1. Select Y(es) to Automatically Update the Number of Remaining Visits and the Remaining Visit Amount.

  2. Click OK .

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• Informational Only Method, click More.

   

  Tips:  

  • When third-party claim forms are generated, the Authorization Number will print in the box 23 of HCFA claim forms or the electronic equivalent.

  • Using this method, the Referral Authorization Number is informational only and you cannot maintain the referral's Remaining Number of Visits and the Remaining Amount.

  Directions:

  To add a Referral Authorization Number to a charge without first creating the referral:

  1. Open Prior Authorization Maintenance.  From the Menu Bar click Billing Functions, and next click Prior Authorization.

  2. At the Prior Authorization Window, enter the Patient Account Number and click Load.

  3. To select a ticket, enter the desired Ticket Number or from the Charge Ticket List Area at the bottom of the window, click to highlight the ticket.

  4. Enter the Authorization Number to be assigned to the ticket.
     Note:  The Authorization Number is not validated.

  5. Click Update Referral Info.
     Note:  To avoid losing your data, you must click Update Referral Info.

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