Authorizations

Files / Authorizations “Cannot Be After Global End Date”

When setting up an authorization of a client, you may receive a Cannot be after global end date  error.

This message simply warns that the end date of the line level authorization code is not matching that of the global end date at the top of the authorization page. To see the end date for the global authorization, simply click Cancel or click outside of the box, and you will see the global authorization settings at the top of the authorization.

 

Files / Authorizations Allowing Overbilling

While creating an authorization, you may want to allow overbilling for frequency amounts such as hours, units, or visits due to make up sessions. However, it is a good practice to not allow over-billing at the group total. To allow overbilling:

  1. Navigate to Files  and open an authorization.
  2. Click on the Authorizations tab.
  3. Click the Edit  icon next to one of the service code groups .
  4. Select the Frequency & Amounts tab.
  5. Under any of your frequencies, click the checkbox  labelled Allow Overbilling.
  6. Click Save.

Note: users with Manage Timesheets permission will still be able to override this setting.

Files / Authorizations Authorization Code Order and Daily Minimum/Maximum

There are certain situations with regards to Authorizations which require one code to be used before another code may be used.  For example, some payors require that 0364T must be used before 0365T may be used.  In this case, you’ll want to use the Enforce Code Order feature.

  1. Make sure you’re on the Authorizations tab within your authorization.
  2. If you’re trying to add a new code group, click Single Service Code or Shared Grouped Codes. If you’re trying to edit an existing group, click the Edit  icon next to that code group .
  3. Navigate to the Service Code(s) tab.
  4. Click the Enforce Code Order button.

This will allow you select the order in which codes must be scheduled and then billed.

Files / Authorizations Create an Authorization

Authorizations are issued by insurance companies with the set of billing codes and service details approved to be provided to the client. Once an authorization has been received for the client’s plan of care, they are to be loaded in CentralReach so that client appointments are scheduled and linked to the approved billing codes and services, and to latter bill for such services. Adding authorization details to CentralReach allows you to streamline billing processes to ensure appointments are scheduled and all client-approved services are billed.

To create an authorization:

  1. Navigate to  Files module and select  Create a New Authorization
  2. Complete the form:
    • Contact Name: enter the name of the client the authorization is being created for
    • Name of Document: enter the name of the authorization document. CentralReach recommends you add the client’s name, the work “auth” and the valid days of the authorization to easily be able to search for the authorization
    • Description: enter a brief description if desired
    • Drop files here to upload: if you have a copy of the authorization file you can upload it by clicking and dragging a file from your computer or by clicking on the box to search your computer for a file. Please keep in mind that you can only upload up to 20 files at a time
    • Click Begin Upload or Continue Without a Document.
  3. Click the Payor of Authorization drop-down and select the payor’s name
  4. Click the Valid Dates of Authorization calendar fields, and enter the start date and the end date of the authorization
  5. Click Continue & Add Service Codes
  6. Click the + Add Codes blue button and select one of the following:
    • Add Single Code: select to enter an authorized amount for a single code. Proceed to step 7 below to add your code.
    • Add Grouped Codes: select to enter an authorized amount that is shared among a set of service codes. Proceed to step 7 below to add your codes.
    • Add from Template: select when you have already set up at least one authorization template and wish to pull the entire template into the authorization file rather than adding each code individually. If selecting a template, complete the following form:
      1. Group Template: click the drop-down and select the template name
      2. Payor: if necessary, edit the payor name previously entered in step 3 above
      3. Valid Dates: if necessary, edit the authorization valid dates previously entered in step 4 above
      4. Authorization #: enter the authorization number
      5. Contacts: allows you to add specific providers for the authorization. These are all optional fields.
        • Manager: enter the name of the employee or BCBA who is in charge of managing this authorization
        • BillingReferringProvider/Supplier, and Facility will pull the information included here into your claim CMS-1500 forms
      6. Click Save
  7. When adding single codes or grouped codes, complete the following steps to add the code details by clicking on each individual tab:
    1. General:
      • Payor: if necessary, edit the payor name previously entered in step 3 above
      • Valid Dates: if necessary, edit the service code authorization valid dates
      • Authorization #: enter the authorization number
      • Diagnosis Codes: enter the client’s diagnosis code to be used for this specific authorization only. Leave blank to use the diagnosis code already saved in the client’s claim settings.
      • Use Service Location: enable to pull the timesheet’s address/location and place of service into the facility address on the claim
    2. Service Code(s): 
      • Service Codes: click to enter the authorized service code(s)
      • Enforce Code Order: when adding more than one code, enable to enforce the code order as entered in the authorization
      • Add a Note: enter a note to be displayed when scheduling a client appointment with this code
    3. Frequency & Amounts: allows you to set the tracking frequency and the authorized amounts (hours, units, visits, etc) for the codes
      1. Frequency & Amounts: click the drop-down to select how frequently the service(s) are to be provided and enter the following values to define the amounts approved for each service (single service code) or for all services (shared group codes):
        • $Amount: enter the dollar amount approved/frequency
        • Hours: enter the total number of hours approved/frequency
        • Units: enter the total number of units approved/frequency
        • Visits: enter the total number of visits approved/frequency
        • Allow Overbilling: click checkbox underneath each item to allow overbilling, so users can continue to submit a timesheet after seeing a warning if the authorized amounts have been exceeded
      2. Click Calculate Totals to allow CentralReach to calculate the Total Group Amounts below based on the values entered above, and the authorization start and end date. Otherwise, proceed to step 3 and calculate your amounts manually.
      3. Total Group Amounts
        • Total $Amount: enter the total dollar amount approved for the authorization length
        • Total Hours: enter the total number of hours approved for the authorization length
        • Total Units: enter the total number of units approved for the authorization length
        • Total Visits: enter the total number of visits approved for the authorization length
        • Allow Overbilling: click checkbox underneath each item to allow overbilling, so users can continue to submit a timesheet after seeing a warning if the authorized amounts have been exceeded.
      4. Calculations: define how to use the authorized hours. Select from the drop-down to Use Actual Values if you are to use the full value of the authorization in a week, regardless of the day of the week when the authorization starts and ends. Select Use Pro-Rated Values if you are to prorate the authorizations values based on the day of the week when the authorization starts and ends.
      5. Validation: will be enabled by default so the authorization is validated when scheduling appointments and converting timesheets. Click to disable.
    4. Contacts: allows you to add specific providers for the authorization. These are all optional fields.
      • Manager: enter the name of the employee or BCBA who is in charge of managing this authorization
      • BillingReferringProvider/Supplier, and Facility will pull the information included in here into your claim CMS-1500 forms
      • Locked for this Provider: enter the name of a provider who you want to be the only one to provide services using the code included in the authorization for the client
    5. Click Save
  8. To add more codes, repeat step 6 above

Files / Authorizations Create an Authorization Template

Authorization templates allow you to create a pre-configured template with a set of authorized service codes that you typically always add to client authorizations, to help you quickly and easily create client authorizations.

To create an authorization template:

  1. Navigate to the Files module and select  Authorization Templates
  2. Click  Add New
  3. Name of Authorization Template: enter the name of the template
  4. Description of Authorization Template: enter a description of the authorization template
  5. Click Create
  6. Client to enter the service codes:
    • Single Service Code: select to enter an authorized amount for a single code
    • Shared Grouped Codes: select to enter an authorized amount that is shared among a set of service codes
  7.  Enter the code details by clicking on each individual tab:
    1. Service Code(s): 
      1. Service Codes: click to enter the authorized service code(s)
      2. Add a Note: enter a note to be displayed when scheduling a client appointment with this code
    2. Frequency & Amounts: we recommend this information is completed once you have a client’s authorization and add the template into it, as the values may vary based on the services approved for each individual client. If you’d like to complete this information in the template:
      • Frequency & Amounts: click the drop-down to select how frequently the service(s) are to be provided and enter the following values to define the amounts approved for each service (single service code) or for all services (shared group codes):
        • $Amount: enter the dollar amount approved/frequency
        • Hours: enter the total number of hours approved/frequency
        • Units: enter the total number of units approved/frequency
        • Visits: enter the total number of visits approved/frequency
        • Allow Overbilling: click checkbox underneath each item to allow overbilling, so users can continue to submit a timesheet after seeing a warning if the authorized amounts have been exceeded
      • Total Group Amounts
        • Total $Amount: enter the total dollar amount approved for the authorization length
        • Total Hours: enter the total number of hours approved for the authorization length
        • Total Units: enter the total number of units approved for the authorization length
        • Total Visits: enter the total number of visits approved for the authorization length
        • Allow Overbilling: click checkbox underneath each item to allow overbilling, so users can continue to submit a timesheet after seeing a warning if the authorized amounts have been exceeded.
      • Validation: will be enabled by default so the authorization is validated when scheduling appointments and converting timesheets. Click Disable Validation to disable it.
      • Enforce Code Order: when adding more than one code, click Enforce Code Order to enforce the code order as entered in the authorization template
      • Click Save
  8. Click Save Template

Files / Authorizations Edit a Client Authorization

To edit a client authorization:

  1. Navigate to the  Contacts module and select Clients
  2. Click the client’s name
  3. Go to the Authorizations widget in the client’s Dashboard
    • To learn how to add the Authorizations widget to the client’s Dashboard, click here
  4. Click the authorization you wish to edit
  5. Edit the Service Codes Limits pop up as considered necessary and click Save Changes. If no edits are required, click Close
  6. Hover over the Global Authorizations Settings box top right corner, and click the pen icon to edit the global authorization settings
    • Edit the information as necessary and click Save Changes
  7. Hover over the Service Code Breakdown box top right corner, and click pen icon to edit the service code details
    • Edit the information as necessary clicking on all the tabs on top of the pop up. Refer to step 10 below with details on the information included in each tab. Once completed, click Save. 
  8. To add new codes to an authorization, click the + Add Codes blue button and select one of the following:
    • Add Single Code: select to enter an authorized amount for a single code. Proceed to step 9 below to add your code.
    • Add Grouped Codes: select to enter an authorized amount that is shared among a set of service codes. Proceed to step 9 below to add your codes.
    • Add from Template: select when you have already set up at least one authorization template and wish to pull the entire template into the authorization file rather than adding each code individually. If selecting a template, complete the following form:
      1. Group Template: click the drop-down and select the template name
      2. Payor: if necessary, edit the payor name previously entered in step 3 above
      3. Valid Dates: if necessary, edit the authorization valid dates previously entered in step 4 above
      4. Authorization #: enter the authorization number
      5. Contacts: allows you to add specific providers for the authorization. These are all optional fields.
        • Manager: enter the name of the employee or BCBA who is in charge of managing this authorization
        • BillingReferringProvider/Supplier, and Facility will pull the information included here into your claim CMS-1500 forms
      6. Click Save
  9. When adding single codes or grouped codes, complete the following steps to add the code details by clicking on each individual tab:
    1. General:
      • Payor: enter the payor name
      • Valid Dates: enter the service code valid dates
      • Authorization #: enter the service code authorization number
      • Diagnosis Codes: enter the client’s diagnosis code to be used for this specific authorization only. Leave blank to use the diagnosis code already saved in the client’s claim settings.
      • Use Service Location: enable to pull the timesheet’s address/location and place of service into the facility address on the claim
    2. Service Code(s): 
      • Service Codes: click to enter the authorized service code(s)
      • Enforce Code Order: when adding more than one code, enable to enforce the code order as entered in the authorization
      • Add a Note: enter a note to be displayed when scheduling a client appointment with this code
    3. Frequency & Amounts: allows you to set the tracking frequency and the authorized amounts (hours, units, visits, etc) for the codes
      1. Frequency & Amounts: click the drop-down to select how frequently the service(s) are to be provided and enter the following values to define the amounts approved for each service (single service code) or for all services (shared group codes):
        • $Amount: enter the dollar amount approved/frequency
        • Hours: enter the total number of hours approved/frequency
        • Units: enter the total number of units approved/frequency
        • Visits: enter the total number of visits approved/frequency
        •  Allow Overbilling: click checkbox underneath each item to allow overbilling, so users can continue to submit a timesheet after seeing a warning if the authorized amounts have been exceeded
      2. Click Calculate Totals to allow CentralReach to calculate the Total Group Amounts below based on the values entered above, and the authorization start and end date. Otherwise, proceed to step 3 and calculate your amounts manually.
      3. Total Group Amounts
        • Total $Amount: enter the total dollar amount approved for the authorization length
        • Total Hours: enter the total number of hours approved for the authorization length
        • Total Units: enter the total number of units approved for the authorization length
        • Total Visits: enter the total number of visits approved for the authorization length
        •  Allow Overbilling: click checkbox underneath each item to allow overbilling, so users can continue to submit a timesheet after seeing a warning if the authorized amounts have been exceeded.
      4. Calculations: define how to use the authorized hours. Select from the drop-down to Use Actual Values if you are to use the full value of the authorization in a week, regardless of the day of the week when the authorization starts and ends. Select Use Pro-Rated Values if you are to prorate the authorizations values based on the day of the week when the authorization starts and ends.
      5. Validation: will be enabled by default so the authorization is validated when scheduling appointments and converting timesheets. Click to disable.
    4. Contacts: allows you to add specific providers for the authorization. These are all optional fields.
      • Manager: enter the name of the employee or BCBA who is in charge of managing this authorization
      • BillingReferringProvider/Supplier, and Facility will pull the information included in here into your claim CMS-1500 forms
      • Locked for this Provider: enter the name of a provider who you want to be the only one to provide services using the code included in the authorization for the client
    5. Click Save

Files / Authorizations How do I add a file to an existing authorization

If you proceeded without a document when originally creating a client authorization, you can add the file whenever it becomes available. To do this:

  1. Navigate to the authorization you’d like to upload a document to.
  2. On the File Details tab, click the  0 Previous Versions button.
  3. Click the  Choose a button that appears.
  4. Search for and select the file from your device.
  5. If you wish to override the file name on CentralReach with the name of the file being imported click the checkbox  next to New file name overrides saved file name.
  6. Click the Upload button once you’re ready to upload.

 

 

 

 

 

 

Files / Authorizations How do I set authorization frequencies?

Do you manage your para-staff on a weekly basis, or supervise them monthly? Whatever your current practice, your workflow will designate how to assign and/or group codes. In CentralReach, you have the following options when setting frequencies:

  • Once: use this when you want to enter authorized amounts for the lifetime of the authorization. If you do not want to to break it down by month or week, and simply want to make sure that a code doesn’t go over a certain amount for the life of the authorization.
  • Daily: every day.
  • Weekly: every week.
  • Bi-weekly: every other week.
  • Monthly: every month. This is the recommended tracking frequency.
  • Quarterly: only use this if the authorization valid dates are for a three month period.
  • Semi-annually: Only use this if the authorization valid dates are for a six month period.
  • Annually: Only use this if the authorization valid dates are for a 12 month period.

To change frequencies within an authorization:

  1. Navigate to Files  and open an authorization.
  2. Click on the Authorizations tab.
  3. Click the Edit  icon next to one of the service code groups .
  4. Select the Frequency & Amounts tab.
  5. Click the Frequency & Amounts dropdown and choose a frequency.
  6. Click Save.

Files / Authorizations Managers, Principals, and Locking Auths to a Provider

Administrators may want to give different levels of access to employees when it comes to Authorizations. CentralReach allows an employee to be designated as a manager, a principal, and a provider, but what’s the difference?

  • Manager: Adding an employee as a manager gives that contact access to a specific code within an authorization so that the employee can only see this line level code from the Authorization Report while not necessarily allowing them to use this code. You can add a manager from within any client’s authorization.
    1. Navigate to Files  and select the authorization you want to edit.
    2. Click the Authorizations tab.
    3. Click the Edit  icon next to one of the service code groups .
    4. Select the Contacts tab and add a contact to the Manager field.
    5. Click Save.
  • Principal: Similar to a manager, adding an employee as a principal gives that contact the ability to view not only just the designated service code but all of the service codes within that authorization of a client from the Authorization report. Just like the manager, adding a principal allows that employee to view all of this client’s authorizations.
    1. Navigate to the Contacts  module.
    2. Click on the client you wish to edit, then select the Profile tab.
    3. Click on the  Principals option and click Add New.
    4. Choose a Principal, Principal Type, Start Date, and choose whether or not to hide the principal from other contacts. An end date is optional.
    5. Click Add Principal.
  • Locked for this Provider: When an authorized service code is locked to a provider, it will allow only that employee to use that code within appointments and timesheets.
    1. Navigate to Files  and select the authorization you want to edit.
    2. Click the Authorizations tab.
    3. Click the Edit  icon next to one of the service code groups .
    4. Select the Contacts tab and add a contact to the Locked for this Provider field.
    5. Click Save.