Funding Source Service Authorization

Authorize services for all members associated to a funding source.

Avatar MSO > Care Management > Funding Source Service Authorization

• If the Member Enrollment form is used, authorizations filed through this form will apply to all members enrolled for the associated funding source.
• If the Member Enrollment form is not used, authorizations filed through this form will be applicable to all myAvatar members.

Prerequisites:

• A member must be enrolled in the Member Enrollment form.
• A funding source must be created in the Funding Source Registration form.

1. In the Select Funding screen, search for and select the funding source.
2. In the Benefit Plan field, select the associated benefit plan.

• The benefit plan will populate if only one benefit plan is associated with the funding source.

3. In the Type of Authorization field, select the authorization type.

• The Authorization Number field displays the service authorization number.

4. In the Authorization Level Of Care field, select the authorized level of care.
5. In the Current Authorization Status Reason field, select the authorization status reason.
6. In the Initial Or Continuing Authorization field:

• Select Initial for the first authorization.
• Select Continuing for an additional member authorization.
• Select Copy to copy information from an existing authorization to the current authorization.

7. In the Begin Date of Authorization field, enter the authorization begin date.

• Services claimed before this date will be denied.

8. In the End Date of Authorization field, enter the authorization end date.

• Services claimed after this date will be denied.

9. In the Next Review Date field, enter the authorization next review date.
10. In the Prevent Approved Services From Pushing To Parent System field, select Yes to stop services associated to the authorization from being pushed to parent myAvatar PM system on claims processing batch closing (regardless of other conditions for services to be pushed).
11. In the Authorization Grouping or Individual Authorizations field:

• Select Grouping to select a Service Authorization Group.
  In the Authorization Grouping field, select the authorization grouping.
• Select Individual to select an individual service.
• Select All to authorize all CPT procedure codes and revenue codes.

12. Click Display Authorization Grouping to generate the Authorization Grouping Definition report, which details authorization grouping information.
13. In the Letter Type field, select the letter type.
14. In the 'Procedure Code Type' fields:

• Select CPT Code for CPT code services.
• Select Revenue Code for revenue code services.

15. In the Code Authorized fields, enter the CPT or Revenue Code, and select.
16. In the 'Units/Visits Authorized' fields, enter the number of units authorized.

• These fields are enabled when Yes is selected in the Member Authorizations Contain Unit Limitations field (Funding Source Registration form).
• If an authorization has claimed services against it, the procedure code for associated services cannot be edited or deleted
• The Unit limit is applied per client.

17. Click Submit.