Payor Based Authorizations form - Cal-PM

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The Payor Based Authorizations form will have different requirements based on whether the Enable CPT Based Payor Authorizations registry setting is enabled.

When the Enable CPT Based Payor Authorizations registry setting is set to ‘N’, the Payor Based Authorizations form includes these fields:

Field	Description
Add/Edit/Delete	Select an action: Add – enter a new Authorization Number Edit – edit an existing Authorization Number Delete – delete an existing Authorization Number
Guarantor	Select the Guarantor(s).
Program	Select the Program(s).
Effective Date	Enter the effective date for the configured Authorization Number. After saving the Payor Based Authorization definition, the system evaluates services that meet the criteria with a Date of Service on or after the Effective Date.
Expiration Date	Enter the expiration date, if applicable.
Practitioner Category	Select the Practitioner Category(ies). Note: If no selections are made, the Authorization Number applies to all Practitioner Categories.
Authorization Group	Select an Authorization Group from the list, if applicable. The ‘Service Code(s)’ field will filter to only Service Codes defined in the selected Authorization Group. Authorization Groups are defined in the Authorization Group Definition form and allow organizations to define groups of Service Codes often authorized together (for example, by Level of Care). This may help to simplify the configuration but is not required.
Service Code(s)	Select the applicable Service Code(s) from the list.
Authorization Number	Enter the Authorization Number. This number is reported on an outbound 837 claim file.
Display Authorizations	Select this button to launch a report that shows Payor Based Authorization definitions.
Select Authorizations to Edit/Delete	Select this button to choose an existing Payor Based Authorization definition to edit or delete.

When the Enable CPT Based Payor Authorizations registry setting is set to ‘Y’, the Payor Based Authorizations form includes these fields:

Field	Description
Add/Edit/Delete	Select an action: Add – enter a new Authorization Number Edit – edit an existing Authorization Number Delete – delete an existing Authorization Number
Guarantor	Select the applicable Guarantor(s).
Program	Select the applicable Program(s).
Effective Date	Enter the effective date for the configured Authorization Number. After saving the Payor Based Authorization definition, the system evaluates services that meet the criteria with a Date of Service on or after the Effective Date.
Expiration Date	Enter the expiration date, if applicable.
Practitioner Category	Select the Practitioner Category(ies). Note: If no selections are made, the Authorization Number applies to all Practitioner Categories.
Authorization Number	Enter the Authorization Number. This number is reported on an outbound 837 claim file.
Select CPT Codes	Select this button to launch a grid if the Authorization Number applies to select CPT Codes. Configure the applicable CPT Codes within the grid.
All CPT Codes	Select 'Yes' if the Authorization Number applies to all CPT Codes.
Display Authorizations	Select this button to launch a report that shows Payor Based Authorization definitions.
Select Authorizations to Edit/Delete	Select this button to choose an existing Payor Based Authorization definition to edit or delete.