Authorizations

Information about Authorizations

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 Authorization Settings Export 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 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 Create a Saved Filter

Once you have 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 add the same filter to their account
  5. The saved filter will be on the left-hand side of the page, under Recommended Filters

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 Export the Authorizations Report

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

To download the Authorizations report:

  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 download icon on the top right-hand side of the grid and select CVS or Text file to download the report
  4. Once generated, the report can 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 How to Use the Authorizations Section of the Billing Module

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

  1. Navigate to the Billing module and select Authorizations
  2. Click on the Filters button to filter the authorizations’ information
  3. In the filters box you can 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. Your search will list information by client name

4. 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. Your Search will list information by client name

5. 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

6. The Validation & Overbilling tab will give you the option to Enable/Disable overbilling settings by Frequency or Total

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

In the Authorizations report, 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 in 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. 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 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. Click here to learn more about the Authorizations 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 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