The Authorizations module handles more than traditional ‘insurance authorizations’. Users can store and create authorizations for any contract service that requires time tracking (i.e. school contracts, staff training hours, private payor services). This provides an excellent way to track time, collect data, and easily report information to not only payors; but supervisors, parents and other stakeholders. In addition, authorizations allow organizations to restrict billing and determine how codes are used by staff.
In determining how to use authorizations, there are a series of questions you need to answer.
1. Do you want to restrict billing?
Do you want to control what codes your staff have access to when submitting timesheets? 99.9% of companies answer – “Yes, we want to restrict billing.“
In that case, the first step is to set your service codes to require an authorization using a default service code setting.
This will ensure a service code can only be billed by a staff if the date of service falls within a matching authorization’s start-end date. This will not yet enforce that a specific provider be authorized for that service. In other words, anyone in the company can use the service code to bill assuming there is a valid authorization on file.
*Best practice recommendation – Set service codes to default and requiring authorizations. This will create ‘Open authorizations’ that any provider can bill against if there timesheet falls in the date range of the authorization.
2. Do you want to lock down billing further to only allow specified providers to see codes?
There are two options for restricting service code use by staff:
Option A – Restrict use at the authorization level using a ‘Provider Specific’ authorization.
In the Contacts section of the authorization, specific providers can be assigned for use. Once locked to a provider, the authorization is no longer considered “open.” In addition, it automatically inserts the default client and provider pay rate for that service code without the need to visit billing settings.
Option B – Restrict use at the service code level using ‘Enforcement’ settings (not Default rate).
Open authorizations are not specific to any single provider and all employees connected to the relevant client can use this authorization to bill assuming they have code access. Setting your codes to an enforce rate other than Default rate can be used will require that a specific rate be set with that client or provider before use. Click here to learn more about enforce rates.
*Best practice recommendation – Restricting at the authorization level using provider specific authorizations has less manual entry. In the situation where, there are situations where the client is charged or staff paid something different from default, then option 2 would be ideal.
Please review the help articles in Authorizations Setup to learn more about how to get started.