Authorizations

Information about Authorizations

Billing / Authorizations “Authorization expired or not valid for service date”

This is most likely due to the fact that the appointment date is past the authorization end date that this appointment was originally coded with. You may encounter this in cases where a recurring appointment series was accidentally set up past the authorization’s end date. Another explanation could be that the appointment series was scheduled to end on the same date as the authorization end date, but the authorization end date was later shortened.

Billing / Authorizations Assign a Task from the Authorization Report

Let’s say that you are looking at authorizations set to expire within 30 days and want to task a billing admin to obtain a new one. If you would like to assign a task from the Authorizations report:

  1. Navigate to Billing  and select Authorizations.
  2. Click the checkbox next to each of the authorizations you would like to create a task for.
  3. Click the Actions  dropdown at the top left of the page and select Add Tasks.

You can then create a task the same way you would from the Tasks module.

Once created, you will see a number under the tasks column , indicating the number of tasks attached to this authorization. You can also click on that number to view more details.

Billing / Authorizations Authorization Report Showing Extra Time In The “Pending” Column

CentralReach’s Authorization report is a great way of tracking approved, worked, and unused clinical hours. It will show you when hours have expired and when you are reaching the end of your bucket of authorized hours. Additionally, you may sometimes see hours in the pending column when there are no scheduled hours.

If you’re seeing additional unused time in the Pending column, please check that all appointments have been converted using the full amount of time scheduled. For example, if an appointment is scheduled for two hours, but the converted timesheet is only for one hour, the authorization report will show the unused hour as pending.

To remove this pending time from the report you can change the duration of the appointment to match the timesheet or vice versa.

Billing / Authorizations Authorization Settings Report

To download the Authorizations Settings report from the Reporting module:

  1. Navigate to the Reporting module and select Report Home
  2. Click Authorizations Settings Export under the Authorizations section
  3. Enter the desired Start Date
  4. Enter the desired End Date
  5. Click Export 
  6. Click  Download

The Authorizations Settings report includes the following information:

  • ResourceId
  • AuthorizationId
  • ClientName
  • DateOfBirth
  • Payor
  • Label
  • MemberID
  • GlobalStartDate
  • GlobalEndDate
  • GlobalAmount
  • GlobalHours
  • GlobalUnits
  • AuthorizedCodeId
  • AuthorizedCode
  • StartDate
  • EndDate
  • LockToEmployee
  • AuthorizationNumber
  • Frequency
  • Amount/Freqency
  • Hours/Frequency
  • Units/Frequency
  • TotalAmount
  • TotalHours
  • TotalUnits
  • AllowOverBillAmount
  • AllowOverBillHours
  • AllowOverBillUnits
  • UseGlobalAmount
  • UseGlobalHours
  • UseGlobalUnits
  • Manager
  • Billing
  • Referring
  • Provider/Supplier
  • Facility
  • Notes
  • DiagnosisCodes
  • DeletedCode
  • UseServiceLocation
  • WorkWeek

Billing / Authorizations Bulk Update Authorization Settings

To save time, you can update certain authorization settings in bulk. To do so:

  1. Navigate to Billing  and select Authorizations.
  2. Click the checkbox next to any of the code groups you wish to update.
  3. Click the Actions  dropdown and select Bulk Update.
  4. From the General tab you can update the Validation & CalculationAuthorization NumberUse Service Location, and add or update your note.
  5. From the Contacts tab you can update the ManagerBillingReferringProvider/SupplierFacility, and Locked for Provider fields.
  6. When you’re done making changes, click Update Selected Authorizations.

Billing / Authorizations Create a Saved Filter

Once you’ve applied the filters you want to save:

  1. Click the Save this view as a filter link at the top of the page.
  2. Choose New filter if you want to create a new filter, or select an existing filter to overwrite it.
  3. Enter a name for the filter.
  4. Select the checkbox  next to Allow others in your organization to subscribe to this filter if you want other employees to be able to add the same filter to their account.

When saved, you will see your saved filter on the left side of the page under Recommended Filters.

Billing / Authorizations Export the Authorizations Report

An Authorizations Report with all authorization details based on a defined date range can be downloaded from the Authorizations section in the Billing module.

To download the Authorizations Report from the Billing module:

  1. Navigate to the Billing module and select Authorizations
  2. Click the toggles on top of the grid to define your date range and add any desired filters
  3. Click the cloud download icon on the top right side of the grid and select CVS or Text file to download your report
  4. Once generated, the report will be available to be downloaded from the Files module

The Authorizations Report includes the following information:

  • Id
  • ResourceId
  • IsActive
  • AllowOverBillHours
  • AllowOverBillUnits
  • AllowOverBillAmount
  • AllowOverBillVisits
  • AllowOverBillHoursTotal
  • AllowOverBillUnitsTotal
  • AllowOverBillAmountTotal
  • AllowOverBillVisitsTotal
  • EnableValidation
  • AuthorizationNumber
  • TasksCompleted
  • Tasks
  • NumTasksOverdue
  • NumTasksDayMatch
  • NumTasksWeekMatch
  • ServiceCodes
  • FollowUpServiceCodes
  • FollowUpStartDate
  • FollowUpEndDate
  • FollowUpId
  • FollowUpResourceId
  • FollowUpAuthorizationNumber
  • clientId
  • clientName
  • ClientFullName
  • frequency
  • managerId
  • managerName
  • implementerId
  • implementerName
  • PayorId
  • Payor
  • ActualStartDate
  • ActualEndDate
  • AuthorizedHoursMonth
  • AuthorizedAmountMonth
  • AuthorizedUnitsMonth
  • AuthorizedVisitsMonth
  • AuthorizedAmountAll
  • AuthorizedHoursAll
  • AuthorizedUnitsAll
  • AuthorizedVisitsAll
  • WorkedVisitsMonth
  • WorkedUnitsMonth
  • WorkedAmountMonth
  • WorkedAmountAgreedMonth
  • WorkedHoursMonth
  • WorkedVisitsAll
  • WorkedUnitsAll
  • WorkedAmountAll
  • WorkedAmountAgreedAll
  • WorkedHoursAll
  • WorkedVisitsAuthRange
  • WorkedUnitsAuthRange
  • WorkedAmountAuthRange
  • WorkedAmountAgreedAuthRange
  • WorkedHoursAuthRange
  • ScheduledVisitsMonth
  • ScheduledHoursMonth
  • ScheduledUnitsMonth
  • ScheduledAmountMonth
  • ScheduledAmountAgreedMonth
  • ScheduledVisitsAll
  • ScheduledHoursAll
  • ScheduledUnitsAll
  • ScheduledAmountAll
  • ScheduledAmountAgreedAll
  • ScheduledVisitsAuthRange
  • ScheduledHoursAuthRange
  • ScheduledUnitsAuthRange
  • ScheduledAmountAuthRange
  • ScheduledAmountAgreedAuthRange
  • ConvertedVisitsMonth
  • ConvertedHoursMonth
  • ConvertedUnitsMonth
  • ConvertedAmountMonth
  • ConvertedAmountAgreedMonth
  • ConvertedVisitsAll
  • ConvertedHoursAll
  • ConvertedUnitsAll
  • ConvertedAmountAll
  • ConvertedAmountAgreedAll
  • ConvertedVisitsAuthRange
  • ConvertedHoursAuthRange
  • ConvertedUnitsAuthRange
  • ConvertedAmountAuthRange
  • ConvertedAmountAgreedAuthRange
  • startDate
  • endDate
  • PendingAmountAll
  • PendingAmountAgreedAll
  • PendingVisitsAll
  • PendingHoursAll
  • PendingUnitsAll
  • PendingAmountMonth
  • PendingAmountAgreedMonth
  • PendingVisitsMonth
  • PendingHoursMonth
  • PendingUnitsMonth
  • PendingAmountAuthRange
  • PendingAmountAgreedAuthRange
  • PendingVisitsAuthRange
  • PendingHoursAuthRange
  • PendingUnitsAuthRange
  • RemainingAmountAll
  • RemainingAmountAgreedAll
  • RemainingVisitsAll
  • RemainingHoursAll
  • RemainingUnitsAll
  • RemainingAmountMonth
  • RemainingAmountAgreedMonth
  • RemainingVisitsMonth
  • RemainingHoursMonth
  • RemainingUnitsMonth
  • RemainingAmountAuthRange
  • RemainingAmountAgreedAuthRange
  • RemainingVisitsAuthRange
  • RemainingHoursAuthRange
  • RemainingUnitsAuthRange
  • UtilizationAmountAll
  • UtilizationAmountAgreedAll
  • UtilizationVisitsAll
  • UtilizationHoursAll
  • UtilizationUnitsAll
  • UtilizationAmountMonth
  • UtilizationAmountAgreedMonth
  • UtilizationVisitsMonth
  • UtilizationHoursMonth
  • UtilizationUnitsMonth
  • UtilizationAmountAuthRange
  • UtilizationAmountAgreedAuthRange
  • UtilizationVisitsAuthRange
  • UtilizationHoursAuthRange
  • UtilizationUnitsAuthRange
  • ClientLabels
  • WorkWeek

Billing / Authorizations Finding Expired or Soon to Be Expired Authorizations

You can review expired or soon to be expired authorizations from the Authorizations report. This is a great tool for tracking and staying on top of your authorizations to ensure that your cash flow is not interrupted. To audit authorizations soon to be expired:

  1. Navigate to Billing  and select Authorizations.
  2. Click on the header of the Until  column and choose a date range.

You can use this audit to see authorizations that have already expired or that will be expiring within a certain date range.

You can also assign tasks from this screen.

 

Billing / Authorizations How do I use the authorizations section of billing?

The Authorization tab within the billing module will provide a quick reference to authorization totals, similar to our Authorization reports that we have available.

 

Then click on the “Filters” button to filter the authorizations’ information.

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In the filters box you can filer by any billing label, client name, provider name, service code, payor, or contact label. You can add additional filters as necessary by typing the filer into the search box. Your Search will list information by client name.

2017-03-14 12_22_34-billingmanager - CentralReach

In the search box you can filer by any billing label, client name, provider name, service code, payor, or contact label. You can add additional filters as necessary by typing the filter into the search box. Your Search will list information by client name.

The search will pull client name, service code(s) authorized, Authorization type (Open if no Provider is listed: Provider if the authorization is limited to a specific provider), Valid dates of the authorization, Hours Authorized, and Units Authorized. If a manager or provider is listed in the authorization, their name will populate in the appropriate box.

Lastly, “Validation and Overbilling” tab will give you the option to Enable/Disable overbilling settings by Frequency or Total

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Billing / Authorizations Monthly (Pro-rated) and Monthly (Actual Values)

In the Authorizations report, you can view the pro-rated total and the actual totals .

  • Pro-Rated: The system calculates the authorized amounts for you. As such, if the authorized weekly amount is set as 10 hours, the system will divide the hours by 7 to calculate the daily amount and then multiply that amount by the number of days within a month, thereby giving you the pro-rated total authorized amount in a single month.

(# of weekly amount / 7 days) x (# of days in a month) =  Monthly (Pro-Rated) amount

Example: (10 weekly hours) / 7 days) x (30 days in a month) = 42.86 hrs of pro-rated monthly authorized hours

  • Actual Values: The system calculates the authorized amount by the weekly basis. As such, if there are 30 days in a single month, with 28 days being counted as 4 weeks, the last 2 days will be calculated as another whole week, thereby causing the calculation of the authorized amount to be resulted in 5 weeks. This will cause the weekly amount of 10 hours to result in 50 hours.

(# of weekly amount) x (# of weeks in a month) = Monthly (Actual Values) amount

Example: (10 weekly hours) x (5 weeks in a month) = 50 hours of monthly actual values amount

Billing / Authorizations Navigate Authorizations in the Billing Module

The Authorizations section within the Billing module allows you to review clients total number of authorized hours, hours with a scheduled appointment, hours worked, pending and remaining, along with a utilization rate so that you can quickly view how well your employees are utilizing their authorized hours. Additionally, reviewing Authorizations helps you ensure your clients are receiving their prescribed services, and that services are being provided in the most efficient way to maximize revenue and billing.

To access and navigate the Authorizations section:

  1. Navigate to the Billing module and select Authorizations
  2. Click the toggles on top of the grid to filter authorizations by Month, Hours, Units, Visits, etc., and define the authorizations to be displayed in the grid
    • The grid defaults to monthly actual (not pro-rated) authorizations with hour amounts. Select All time to see the entire authorization period amounts and choose to look at Units or Visits
    • Click Filters for additional options to filter the authorizations grid by or to search by an Authorization #
  3. The authorizations grid includes the following details
    • Checkbox : click to enable the Actions  options to Add Tasks, Bulk Update, Generate Custom ISA Report or Generate Custom ISA BAC Report
    • : identifies the total number of tasks created for each authorization
    • Client : client name
    • Code(s): service codes that are authorized for the client
    • Valid from : start date of the authorization
    • Until : end date of the authorization
    • Payor : insurance company linked to the authorization. Click to filter by payor name.
    • Manager : manager name if listed on the authorization set up. Click to filter by manager name.
    • Locked for name of a provider if the authorization was locked down to a specific provider. This field lists the provider name when a service code is locked to be used by a specific provider for the client. Click to filter by locked and unlocked authorizations.
    • Frequency : indicates the authorization’s frequency
    • Authorized: number of hours/units/visits allowed per month. Click to expand filters.
    • Worked: number of hours worked under the authorization. Click to expand filters.
    • Pending: number of hours not yet converted on the schedule for the authorization. Click to expand filters.
    • Remaining: number of hours still available to be scheduled or worked on the authorization for the month. Click to expand filters.
    • Utilization: percentage of the authorization that has already been worked on for the month. To have maximum utilization, so that all hours are worked, the goal is to get the utilization rate to 100%. Click to expand filters.
  4. Click the download and select CVS or Text file to export an Authorizations Report with further details. To learn more about the Authorizations Report, click here. 

Billing / Authorizations Verify an Authorization

Once you’ve verified that the details of an authorization are correct, we recommend you use the verification feature. By verifying an authorization you are stating that all of the information within the auth is correct. This adds an additional level of accountability and ownership over your authorizations and will help minimize mistakes. To verify an authorization:

  1. Navigate to Files .
  2. Open the authorization you wish to verify and click on the Authorizations tab.
  3. Check the details of the authorization to ensure they are correct.
  4. Within the Global Authorization Settings section, click the Verify Now button.
  5. Add an optional note and click Verify.

If you clicked this button by accident, you can use the Remove button to un-verify the authorization. A record of both actions will be kept in the authorization history.

Billing / Authorizations Why is a deleted authorization still showing up on my authorization report?

If you are still able to see a deleted authorization file in your Authorization report, this is most likely due to the fact that the codes within that authorization are either still attached to appointments (indicated by the Pending column ) or timesheets (indicated by the Worked column ). Clicking on these hyperlinks will take you to the corresponding appointments and billing entries, respectively. You will also see the text Deleted next to the authorization name to display its status.