Authorization Information Section - PM

Authorization Information can be configured by Guarantor/Payor.

Prerequisite:

• The Authorization Group(s) field is enabled when the Require Authorizations At Guarantors/Payors Level registry setting is set to 'Y'.

1. Go to Avatar PM > System Maintenance > System Definition > Guarantors/Payors > Authorization Information.
2. In the Verify Services and Appointments Against Available Authorizations field, select the item(s) that myAvatar will check. Multiple selections are allowed.
   • If Check For Available Dollars is selected, the system compares the cost of the service(s) rendered against the amount entered in the Maximum Dollar Amount field for the authorization in the Managed Care Authorizations form. If the cost of the service(s) is less than or equal to the dollar amount defined in the Maximum Dollar Amount field, the service(s) is covered by the authorization. If the cost of the service(s) is greater than the dollar amount defined in the Maximum Dollar Amount field, the service(s) may not all be covered by the authorization.
   • If Check For Available Units is selected, the system compares the number of units of the service(s) rendered against the amount entered in the Maximum Units field for the authorization in the Managed Care Authorizations form. If the cost of the service(s) is less than or equal to the number of units in the Maximum Units field, the service(s) is covered by the authorization. If the cost of the service(s) is greater than the number of units in the Maximum Units field, the service(s) may not all be covered by the authorization.
   • If Check For Available Visits is selected, the system compares the number of visits of the service(s) rendered against the amount entered in the Maximum Visits field for the authorization in the Managed Care Authorizations form. If the cost of the service(s) is less than or equal to the number of visits in the Maximum Visits field, the service(s) is covered by the authorization. If the cost of the service(s) is greater than the number of visits in the Maximum Visits field, the service(s) may not all be covered by the authorization.
3. In the Verification Level for Authorizations fields, select whether to Disallow the Service or just Warn the User if the Authorization Is Missing; first for Client Charge Input, then for Appointment Scheduling. The Netsmart best practice is that these fields be set to Warn User if Authorization Is Missing. 
4. Specify the Verification Level For Authorizations For 837 Electronic Billing. When an error is reported, myAvatar can also include it on the bill. The Netsmart best practice is that these fields be set to Report As Error And Include On Bill so that claims can be sent and meet timely filing standards. 
5. In the Split the Service If The Authorization Does Not Cover Units field, indicate whether or not to split the service when the amount of units for the service goes over the available units left for the authorization at the time of filing. This is situationally used and is dependent on the payor's authorization requirements.
   • The service will be split into two services. The first service will contain the available amount of units left for the authorization, and the second service will contain the remaining amount.
   • This check must be performed each time a service is filed and could affect the performance of processes such as posting the Room and Board Worklist.
6. Select which bills to sort by authorization number. Multiple selections are allowed. 
   • For the bill(s) selected, a new bill will be generated each time an authorization period ends.
   • When authorization sort isn't selected for a bill, the authorization number used will be the last valid row entered from Managed Care Authorizations or Cross Episode Managed Care Authorizations.
7. In the Authorization Group(s) field, select the groups to apply to this guarantor authorization. This will then auto populate the preselected service codes from the Authorization Group as defined in Authorization Group Definition.
   • The Authorization Group drop-down in the Payor Based Authorizations, Guarantors/Payors (Authorization Information), Managed Care Authorizations (Managed Care Authorization Data), and Cross Episode Managed Care Authorizations forms will be limited to the selections made here based on guarantor. If no selections are made for a Guarantor, the drop-downs will be populated with all authorization groups. 
8. The Authorization Group Information window displays all previously associated authorization information for the guarantor.
9. In the Select Authorization Item field, select a line item from the Authorization Information window to edit or delete.
10. In the Effective Date field, enter the first day this authorization will be active.
11. In the Expiration Date field, enter the last day this authorization will be active.
12. Select the Authorization Group from the drop-down to apply to this guarantor authorization.
13. In the Service Code(s) field, select all services codes to apply to this authorization. The values in this field are filtered based on the group selected in the Authorization Group field.
14. In the Require Authorization field, select whether or not to require an authorization for the selected service code(s).
    • If Yes, select whether or not to require an authorization number in the Require Authorization Number field. The Netsmart best practice recommendation is to require the authorization number when entering authorizations. There may be use cases where the authorization number shouldn't be required (e.g. when entering an authorization to track utilization). If the Require Authorization Number field is set to No, an authorization that does not include an Authorization Number can cover the services.
15. Select Update to save the configuration for this authorization information.
16. Select Delete to remove this authorization information.
    Note: These saved changes or removals will only be filed once the form has been processed.

► SQL Tables

• SYSTEM.billing_guar_table
• SYSTEM.billing_guar_auth_table

► See Also

• Authorization Group Definition - PM
• Payor Based Authorizations - PM
• Managed Care Authorizations - PM
• Managed Care Authorizations Data - PM
• Cross Episode Managed Care Authorizations - PM
• Managed Care Authorizations by Provider - PM
• Managed Care Authorizations By Provider Data - PM