To edit a client authorization:
- Navigate to the Contacts module and select Clients.
- Click the client’s name.
- 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.
- Click the authorization to edit.
- Edit the Service Codes Limits pop-up, if necessary, and click Save Changes.
- If no edits are required, click Close.
- Hover over Global Authorizations Settings and click the pencil icon on the right-hand side.
- In the “Global Authorizations Settings” pop-up, edit the Payor, Valid Dates, and Validation & Calculation if necessary.
- Click Save Changes.
- Select the “Authorization Claim Settings” to input EPSDT referral and contract type codes, an open text field for reference identification, and G2 and LU fields, if necessary.
- Please note, the Authorization Claim Settings will override settings in the Accepted Insurances screen.
- Click Save Changes.
- In the “Global Authorizations Settings” pop-up, edit the Payor, Valid Dates, and Validation & Calculation if necessary.
- Hover over Service Code Breakdown and click the pencil icon on the right-hand side.
- Edit the information, clicking all of 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.
- Edit the information, clicking all of the tabs on top of the pop-up. Refer to step 10 below with details on the information included in each tab.
- Click the + Add Codes blue button and select one of the following:
- Add Single Code: an authorized amount for a single code. Proceed to step 10 below to add the code.
- Add Grouped Codes: an authorized amount that is shared among a set of service codes. Proceed to step 10 below to add the codes.
- Add from Template: select when you have already set up at least one authorization template and want to pull the entire template into the authorization file, rather than adding each code individually. If selecting a template, complete the following form:
- Group Template: click the drop-down and select the template name.
- Payor: if necessary, edit the payor name previously entered in step 3 above.
- Valid Dates: if necessary, edit the authorization valid dates previously entered in step 4 above.
- Authorization #: the authorization number.
- Contacts: 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.
- Billing, Referring, Provider/Supplier, and Facility will pull the information included here into your claim CMS-1500 forms.
- Click Save.
- When adding single codes or grouped codes, click each of the following tabs to add code details:
- General:
- Payor: the payor name.
- Valid Dates: the service code valid dates.
- Authorization #: the service code authorization number.
- Diagnosis Codes: 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 (not commonly used).
- Service Code(s):
- Service Codes: 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 (not commonly used).
- Add a Note: a note to be displayed when scheduling a client appointment with this code.
- Frequency & Amounts: set the tracking frequency and the authorized amounts (hours, units, visits, etc.) for the codes.
- 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: the dollar amount approved/frequency.
- Hours: the total number of hours approved/frequency.
- Units: the total number of units approved/frequency.
- Visits: the total number of visits approved/frequency.
- Allow Overbilling: click the 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.
- 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.
- Please note, if using CentralReach to calculate totals, please confirm they are correct, as midweek or mid-month start/end dates might not tally as expected.
- Click Calculate Frequency to allow CentralReach to calculate the frequency $ amount, hours, units, and visits based on values entered in Total Group Amount.
- Total Group Amounts: if not using CentralReach to calculate totals, enter them manually in the fields below.
- Total $Amount: the total dollar amount approved for the authorization length.
- Total Hours: the total number of hours approved for the authorization length.
- Total Units: the total number of units approved for the authorization length.
- Total Visits: the total number of visits approved for the authorization length.
- Allow Overbilling: click the 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.
- 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 frequency, regardless of the day when the authorization starts and ends. Select Use Pro-Rated Values if you are to prorate the authorization’s values based on the day when the authorization starts and ends.
- Validation: will be enabled by default, so the authorization is validated when scheduling appointments and converting timesheets. Click the toggle to disable.
- Client Accepted Hours: set the number of accepted hours per service code.
- Hours: enter the number of accepted hours.
- Frequency: select either Weekly or Monthly.
- 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):
- Contacts: add specific providers for the authorization. These are all optional fields.
- Manager: the name of the employee or BCBA who is in charge of managing this authorization.
- Billing, Referring, Provider/Supplier, and Facility pulls the information included in here into your claim CMS-1500 forms.
- Locked for this Provider: the name of a sole provider who provides services using the code included in the authorization for the client.
- General:
- Click Save.