Information about Authorizations

Billing / Authorizations Updating a Client’s Group-Level

When a client’s insurance expires and their global settings have been changed to the new payor, each group-level needs to also be changed to the current payor. Updating the payor in the “Global Settings” will not update the “Group-Level” codes. Each grouped service code needs to be changed, as well.

To do this:

  1. Open the client’s authorization that needs to be updated.
  2. Click the pencil icon next to the group of codes to edit the information set for that group.

3. It will open a pop-up window with what is currently set for that group of codes. The “General” tab is where payor information can be updated.

4. Click the down arrow to the right of the payor’s name to update what is currently set.

5. Select the updated payor and click Save

These steps need to be repeated for every group of codes within the authorization.

Billing / Authorizations The Authorization Settings Report

To download the Authorizations Settings Export report:

  1. Navigate to the Insights module and select Report Home.
  2. Click Authorizations under Reports on the right-hand side and select Authorization Settings Export.
  3. Enter the desired Start Date.
  4. Enter the desired End Date.
  5. Click  Export.
  6. Click  Download.
  7. Or, click Go To Files to access the report in the Files module.

The Authorizations Settings Export 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/Frequency
  • 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 How to Download the Authorizations Report

The Authorization export report contains all authorization details based on date range in the Billing module.

To download the Authorizations report:

  1. Navigate to the Billing module and select Authorizations.
  2. Select any filters at the top of the screen and choose a desired date range.
  3. Click the cloud  icon on the top right-hand side and select CVS or Text file.
  4. After selecting “CSV,” click Download in the “Export” pop up. The file will be downloaded to your computer and located in the Files module.
  5. After selecting “Text file,” the file will be generated and located in the Files module.

Click here to view a sample of the Authorization report.

Billing / Authorizations Staff Working Over their Authorized Hours

If you find that your staff worked more than their authorized hours, it is most likely due to any of following reasons:

  1. The billing entries were converted during the authorization report’s refreshed cycle (done every 20 minutes on average and indicated on the top right-hand side corner of the Authorizations screen). To verify this, review the timesheet conversion times:
    • Navigate to the Billing module and select Billing.
    • Click the gear  icon under the Options column, next to the billing entries you want to validate, and select Preview Entry.
    • Click the History tab to review the exact timesheet conversions times and dates.
  2. A duplicate authorization was entered for the same code. To verify this, review the authorizations and file ID’s:
    • Navigate to the Billing module and select Billing.
    • Hover over each authorization under the Service/Auth  column.
    • Review the information displayed on the bottom of the screen and confirm the entries have the same ?id and authorization&authorizationId.

3. Appointments were converted by an employee with the (Billing > Manage Timesheets) permission.

4. The authorization had overbilling enabled when the appointment was converted.

5. Validations are turned off at the authorization level.

Billing / Authorizations Assign a Task from the Authorizations Report

When looking at authorizations set to expire within 30 days and you want to task a billing admin to obtain a new one, assign a task from the Authorizations report.

To assign a task from the Authorizations report:

  1. Navigate to the Billing module and select Authorizations.
  2. Click the checkbox next to each of the authorizations you want to create a task for.
  3. Click the Actions drop-down at the top left of the page and select Add Tasks.
  4. You can then create a task the same way you would from the Tasks module.
  5. Once created, there will be a number under the tasks column, indicating the number of tasks attached to the authorization(s), as seen below. You can also click on that number to view more details.

Billing / Authorizations Verify an Authorization

Once you have verified that the details of an authorization are correct, use the verification feature. By verifying an authorization, you are stating that all of the information 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 the Files module and select All Files.
  2. Click Authorized at the top of the grid and select the authorization you want to verify.
  3. In the authorization, click on the Authorizations tab.
  4. Check the details of the authorization to ensure they are correct.
  5. In the Global Authorization Settings section, click Verify Now.
  6. Add an optional note and click Verify.
    • If you clicked this button by accident, use the Remove button to unverify the authorization. A record of both actions will be kept in the authorization history.

Billing / Authorizations Bulk Update Authorization Settings

To save time, 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 want to update.
  3. Click the Actions  drop-down and select Bulk Update.
  4. From the General tab, update the Validation & Calculation, Authorization Number, Use Service Location, and add or update your note.
  5. From the Contacts tab, update the Manager, Billing, Referring, Provider/Supplier, Facility, and Locked for Provider fields.
  6. Click Update Selected Authorizations.

Billing / Authorizations Navigate Authorizations in the Billing Module

The Authorizations section in the Billing module allows users to review clients’ total number of authorized hours, hours with a scheduled appointment, hours worked, pending, and remaining, along with a utilization rate, to quickly view how well employees are utilizing their authorized hours. Reviewing authorizations ensures that 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 prorated) 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 or Bulk Update.
    • : 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 download and select CSV or Text file to export an Authorizations Report with further details.

Billing / Authorizations Finding Expired or Soon to be Expired Authorizations

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 module 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 to Use the Authorizations Section of the Billing Module

The Authorization tab in the Billing module provides a quick reference to authorization totals, similar to the Authorization report.

  1. Navigate to the Billing module and select Authorizations.
  2. Click the Filters button to filter the authorizations’ information.
  3. In the search box, filter by any billing label, client name, provider name, service code, payor, or contact label. Add additional filters as necessary, by typing the filter into the search box. The Search will list information by client name.
  4. The search will pull client names, 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.
  5. The Validation & Overbilling tab provides the option to enable/disable overbilling settings by Frequency or Total.