Authorization Appeal

​Submit an authorization appeal for a service authorization that has been denied. Denials are issued to the providing contractor through EOBs.
Note: This is a user-defined form.

Prerequisites:

• A service authorization must have been denied in the Create EOB form.

1. ---

   Go to: Avatar MSO > Care Management > Authorization Appeal

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

3. In the Date appeal received field, enter the date the appeal was received.

4. In the Initiating Party field:

• Select Member if a member initiated the appeal.

• Select Provider / Facility if the appeal was initiated by the provider or facility.

4. In the Authorization Appeal Type field, select the type of appeal.

5. The Member Name field displays the member the appeal is for.

6. In the Responsible Provider / Facility field, enter the provider name, and select.

7. In the Contract field, enter the funding source name, and select.

8. In the Plan field, enter the plan name, and select.

9. In the Authorization Number field, enter the authorization number of the disputed authorization.

10. In the Indicate the reasons that this authorization should be reconsidered field, enter why the authorization should appealed.

11. In the Supporting clinical documentation field, enter clinical documentation to support the appeal.

12. When finished, click Submit.

► Additional Sections

• Review Data
• View Authorizations

► SQL Table 

• SYSTEM.user_appeal_auth