About Payor-Based Authorizations - Cal-PM

Payor-based authorizations allow organizations to configure non-client-specific authorization number(s) that need to be reported on outbound electronic claim files. These types of authorizations generally authorize an organization to provide certain services to any client throughout a fiscal year.

When 837 electronic claims need to report non-client-specific authorization number(s), use the Payor Based Authorization form to configure which authorization number(s) to report, based on the Effective Date Range, Guarantor, Program, Service Code, and Practitioner Category combination. No overlapping definitions are allowed.

Payor-based authorization numbers will only report on 837 electronic claim files. When generating an 837 bill, these authorizations apply to clients who have not been authorized for the guarantor and service through the Managed Care Authorizations form.