Prior Authorization Maintenance

Use Prior Authorization Maintenance to attach a referral authorization to a charge or to view referrals already associated with charges. You need to attach a referral to a charge for billing purposes and to be able to print the referral authorization on the HCFA claim form. You can use this program to attach a referral during Charge Entry at the time you enter the charge, or you can attach a referral at a later time by launching this program from the Billing Functions menu. You can attach referrals to tickets for charges before or after building the billing work file, but it must be done before you print claims. The table following the window example describes the Prior Authorization Maintenance window.

For additional information, click More.

Directions:

To display the Prior Authorization Window:

From Charge Entry at the Commit Charges Window, click Yes to Prior Authorization, and next click Commit.
Or, from the Menu Bar click the following sequence: Billing Functions; Prior Authorization.
Keyboard shortcut: [ALT] [b] [p]

General Procedure:

Enter one or more values in the Search Parameter Area and click Load to display the matching tickets in the Charge Ticket List Area.
Select the ticket that needs an authorization referral attached.
Enter the Authorization Number in the Attach Referral Area and then click Update Referral Info.

Prior Authorization Window Example:

Prior Authorization Maintenance Window Prompts

Tip: To see more information about a field, click the hyperlink for the field name.

Search Parameters Area

You can narrow the patient's ticket display by specifying a provider, a location or an insurance. To narrow the patient's ticket display, enter one or more of the following:

Account #

Enter the Patient Account Number of the patient requiring the prior authorization. (up to 6 characters)
Required

Tips:

To search for the appropriate patient Account Number, click Search .
Keyboard shortcut: [CTRL + f].

The Patient's first and last name display for your reference.

Insurance

To include all tickets, leave Insurance blank. Or, to limit the display of tickets assigned to a specific insurance, enter the Insurance Code. (up to 5 characters)

Tips:

To search for the appropriate Insurance Code, click Search .
Keyboard shortcut: [CTRL + f].
The description displays for your reference.

Location

To include all tickets, leave the Location Code blank. Or, to limit the display to tickets assigned to a specific location, enter the Location Code. (up to 2 characters)

Tips:

To search for the appropriate Location Code, click Search .
Keyboard shortcut: [CTRL + f].
The description displays for your reference.

Provider

To include all tickets, leave the Provider Code blank. Or, to limit the display of tickets to those assigned to a specific provider, enter the Provider Code. (up to 4 characters)

Tips:

To search for the appropriate Provider Code, click Search .
Keyboard shortcut: [CTRL + f].
The description displays for your reference.

Accept Assignment

To include all tickets in the display, click Both in the drop-down list.

To limit the ticket display to tickets with Accept Assignment set to Yes, click Yes in the drop-down list.

To limit the ticket display to tickets with Accept Assignment set to No, click No in the drop-down list.

Billed/Unbilled

The Billed Charge Selection Option allows you to limit the list of tickets displayed in the list.

To display both billed and unbilled tickets, click Both in the drop-down list.
To limit the ticket display to billed tickets, click Billed in the drop-down list.
To limit the ticket display to unbilled tickets, click Unbilled in the drop-down list.

To display the desired tickets for charges associated with the patient, click Load or press [ENTER].

Keyboard shortcut: [Alt + l]

Attach Referral Area

Use this area to attach the Authorization Number for a referral to a specific charge ticket.

Ticket Number

To select a service, enter the Ticket Number or from the Patient Ticket Search area below click to highlight the desired service line. (7.0 numeric)

Insurance Company

Displays the Insurance Code and Insurance carrier's name for your reference.

Note: Although it is possible to change the Insurance Code for the authorization referral record, you will not see the change because the Insurance Code for the ticket remains unchanged.

Tip: To search for an existing Insurance Code, click Search .

Authorization #

To add a referral authorization to a ticket, enter a valid Patient Referral Authorization Number maintained during Patient Entry at the Referral Authorization Window.

Or, enter a new Authorization Number. (up to 15 characters)

Notes:

To search for an existing Authorization Number, click Search .
From the Referral Authorization Search Window, click to highlight the desired Authorization and click Select to assign to the ticket.
Keyboard shortcut: press [CTRL + f]
If you add a pending or expired Authorization Number to a charge you will have to maintain Remaining Visits manually and a message on the Status Bar alerts you.
If you enter an Authorization Number here that was not created during Referral Authorization, it is informational only. It will print in box 23 of the HCFA claim form, but will not track the referral's Remaining Visits.

To add the Authorization Number to the charge, click Update Referral Info or press [ENTER].

Keyboard shortcut: [ALT + s]

CAUTION

To add an Authorization Number to a ticket and to update the referral's Remaining Visits and Status if applicable, you must click Update Referral Info.

Charge Ticket List Area

Ticket Search List

The Ticket List Area displays the following fields associated with patient tickets:

To close the Prior Authorization Window, click OK, or press [ENTER].

Keyboard shortcut: [ALT + o]

To close the Prior Authorization Window, click Cancel.

Keyboard shortcut: [Alt + c]