Service Authorization (Unlimited Codes)

Manage service authorizations for a member.

myAvatar MSO > Care Management > Service Authorization (Unlimited Codes)

• Each service authorization covers a contracting provider, and funding source.

• Service authorizations are used in the Fast Service Entry, and claim processing forms.

• Services must be associated with a service authorization in order to be reimbursed.

• Editing a field that alters service availability can be adjudicated through the Manual Batch Adjudication form (open batches), and Retro Claim Adjudication form (closed batches).

• The same procedure code may be entered multiple times, as long as the Begin and End Date Of Service dates do not overlap with each other.

Prerequisites:

• A member must be enrolled in the Member Enrollment form.

1. In the Select Client screen, search for and select a client by name or ID.

• If the client has previous service authorizations, a pre-display displays.
• Select an authorization to edit, or click Add to create an authorization.
• Click Delete to delete an authorization.
• Authorizations that have not been claimed cannot be deleted.

2. Click Brief Member Review to generate the Brief Member Review report, that details the member's diagnosis and treatment information.

• Treatment information details services contained in EOBs in the last 180 days.

3. Click Member Authorization History to generate the Member Authorization History report, that details the member's previous service authorizations.

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

5. The Authorization Number field displays the service authorization number.

6. In the Funding Source Authorization Is For field, select the funding source.

7. The Benefit Plan field displays the assigned plan.

8. In the Provider To Be Authorized field, enter the provider name, and select.

9. In the Performing Provider field, select the facility member.

• If the performing provider associated with the service is different then the provider in the authorization, the service will be denied.

10. In the Performing Provider Type field, select the provider type.

11. In the Planned Admit Date field, enter the planned admission date.

12. In the Authorized Level of Care field, select the level of care.

13. In the Current Authorization Status field, select Approved if this authorization has been approved.

14. In the Current Authorization Status Reason field, select the authorization status reason.

15. In the Account field, select the budget tracking account.

16. In the Initial or Continuing Authorization field, select Initial if this is the member's first authorization. Select Continuing for an additional member authorization.

17. Select Copy to copy information from an authorization to the current authorization.

• The Authorization Listing screen displays. Select the service authorization, click Ok.
• The authorization end date populates the Begin Date of Authorization field.

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

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

20. In the Next Review Date field, enter the authorization next review date.

21. In the Authorization Grouping or Individual Authorizations field:

    • Select Grouping to select a Service Authorization Group.

    • Select Individual to select an individual service.

    • Select All to authorize all CPT procedure codes and revenue codes.

22. In the Authorization Grouping field, select the authorization grouping.

23. Click Display Authorization Grouping to generate the Authorization Grouping Definition report, which details authorization grouping information.

24. The Total Estimated Liability field displays the total liability codes, for the authorized service codes.

25. In the Letter Type field, select the letter type.

26. Click Launch Grid.
    The Service Authorizations Unlimited Codes screen displays.