Authorizations

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 want 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 Global Authorizations Settings‘ top right corner and click the pen icon to edit the global authorization settings
    • Edit the information and click Save Changes
  7. Hover over Service Code Breakdown‘s top right corner, and click the pen icon to edit the service code details
    • 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
  8. To add new codes to an authorization, 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 9 below to add your code
    • Add Grouped Codes: 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 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
        • BillingReferringProvider/Supplier, and Facility will pull the information included here into your claim CMS-1500 forms
      • 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:
    • 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. Otherwise, proceed to step 3 and calculate your amounts manually. Please note, if you use CR to calculate totals, please confirm they are correct, as midweek or mid-month start/end dates might not tally as expected
      • Total Group Amounts
        • 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 to disable
    • 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
      • BillingReferringProvider/Supplier, and Facility pulls the information included in here into your claim CMS-1500 forms
      • Locked for this Provider: 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
    • Click Save

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 can be used. For example, some payors require that 0364T must be used before 0365T can be used. In this case, use the Enforce Code Order feature.

  1. Navigate to the Authorizations tab in the authorization
  2. If you are trying to add a new code group, click Single Service Code or Shared Grouped Codes. If you are 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 Adding a File to an Existing Authorization

If a client authorization was originally created without a document, add the file whenever it becomes available.

To do this:

  1. Select the authorization to upload a document to
  2. On the File Details tab, click the  0 Previous Versions button
  3. Click  Choose a button that appears
  4. Search for and select the file from your device
  5. If you want 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

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 later 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: the name of the client the authorization is being created for
    • Name of Document: 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 search for the authorization
    • Description: 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 note, up to 20 files can only be uploaded 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 and 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: an authorized amount for a single code. Proceed to step 7 below to add your code
    • Add Grouped Codes: 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 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 number: the authorization number
      • 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
        • BillingReferringProvider/Supplier, and Facility: pulls the information included here into your claim CMS-1500 forms
      • 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:
    • 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 number: the 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
      • Click here to learn how to enforce a Place of Service
    • 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. Otherwise, proceed to step 3 and calculate your amounts manually. Please note, if you use CentralReach to calculate totals, please confirm they are correct, as midweek or mid-month start/end dates might not tally as expected
      • Total Group Amounts
        • 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 Use Actual Values from the drop-down, if you are using 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 to disable
    • 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
      • BillingReferringProvider/Supplier, and Facility: pulls the information included in here into your claim CMS-1500 forms
      • Locked for this Provider: 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
    • Click Save
  8. To add more codes, repeat step 6 above

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

Administrators can give different levels of access to employees when it comes to Authorizations. CentralReach allows an employee to be designated as a manager, principal, and a provider.

  • Manager: adding an employee as a manager gives that contact access to a specific code within an authorization, so 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. To do so:
    1. Navigate to the  Files module 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 allows that contact to view not only 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. To do so:
    1. Navigate to the  Contacts module and select Everyone
    2. Click on the client you want 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. To lock a service code to a provider:
    1. Navigate to the  Files module 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

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 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, click Cancel or 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, 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 overbilling at the group total.

To allow overbilling:

  1. Navigate to the  Files module 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  labeled Allow Overbilling
  6. Click Save

Please note, users with the (Billing > Manage Timesheets) permission can still override this setting.

Files / Authorizations Setting Authorization Frequencies

In CentralReach, the following are 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 want to ensure that a code does not 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: four times a year, such as 1/1-3/31, 4/1-6/30, 7/1-9/30, 10/1-12/31
  • Semi-annually: two times a year, such as 1/1-6/30, 7/1-12/31
  • Annually: one time a year, such as 1/1-12/31

To change frequencies within an authorization:

  1. Navigate to the   Files module and select All Files
  2. Open an authorization and 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 drop-down and choose a frequency
  6. Click Save

Files / Authorizations Create an Authorization Template

Authorization templates allow you to create a pre-configured template with a set of authorized service codes that are typically always added to client authorizations, to help you 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: an authorized amount for a single code
    • Shared Grouped Codes: an authorized amount that is shared among a set of service codes
  7.  Enter the code details by clicking on each individual tab:
    • Service Code(s):
      • Service Codes: the authorized service code(s)
      • Add a Note: a note to be displayed when scheduling a client appointment with this code
    • Frequency & Amounts: we recommend this information is completed once you have a client’s authorization and add the template into it, as the values can vary based on the services approved for each individual client. If you want 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: 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
      • Total Group Amounts
        • 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.
      • Validation: will be enabled by default so the authorization is validated when scheduling appointments and converting timesheets. Click Disable Validation to disable it (not recommended)
      • Enforce Code Order: when adding more than one code, click Enforce Code Order to enforce the code order as entered in the authorization template (not commonly used)
      • Click Save
  8. Click Save Template