Avatar MSO 'Service Authorization' Form
Note - These testing guidelines assume the user is skilled in the use of, at a minimum, the following:
- Procedure Code Group Definition
- Provider Fee Definition
- Registry Settings (PM)
- Service Authorization
Scenario 1: 'Service Authorization' - Verification of 'Restrict Code Authorized By Provider' Registry Setting
Specific Setup:
- Avatar MSO Registry Setting 'Restrict Code Authorized By Provider' must be enabled
- One or more Procedure Code Group(s) including CPT Codes must be defined (via Avatar MSO 'Procedure Code Group Definition' form)
- Provider Fee Definition(s) must be defined by Procedure Code Group for Contracting Provider (via Avatar MSO 'Provider Fee Definition' form)
Steps
- Open Avatar MSO 'Service Authorization' form.
- Select Client ID for 'Service Authorization' entry.
- Click 'Add' button in 'Service Authorization' form pre-display to enter a new record, or select existing row/record and click 'Edit' button to view/update existing record.
- Enter/select values for 'Funding Source Authorization Is For', 'Benefit Plan', 'Provider To Be Authorized', 'Begin Date Of Authorization', 'End Date Of Authorization' and 'Current Authorization Status' fields.
- Select 'Individual' in the 'Authorization Grouping Or Individual Authorizations' field.
- Select 'CPT Code' in the 'Procedure Code Type' field.
- Enter search term for CPT Code in 'Code Authorized' field.
- In 'Code Authorized' field search results - ensure that only CPT Codes where Provider Fee Definition for selected 'Provider To Be Authorized' are included/available for selection, including CPT Codes where applicable Provider Fee Definition is defined by Procedure Code Group for Contracting Provider.
- In 'Code Authorized' field search results - ensure that CPT Codes where no Provider Fee Definition exists for selected 'Provider To Be Authorized' are not included/not available for selection.
- Select search result/CPT Code in the 'Code Authorized' field and enter value for corresponding 'Units Authorized' field; if enabled, ensure that 'Estimated Liability Code' field value is populated based on Provider Fee Definition for selected 'Code Authorized'/'Units Authorized' field entries where applicable Provider Fee Definition is defined by Procedure Code Group for Contracting Provider.
- Enter/select values for any other fields in form as required/desired.
- Click 'Submit' button to file 'Service Authorization' form/record.
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Topics
• NX
• Registry Settings
• Service Authorizations
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