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Authorization Information Section - Cal-PM

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Configure authorization information 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. For Verify Services and Appointments Against Available Authorizations, select the item(s) that myAvatar will check. Multiple selections are allowed.
    • Selecting Check For Available Dollars compares the cost of the service(s) rendered against the Maximum Dollar Amount entered for the authorization in the Managed Care Authorizations form. If the cost of the service(s) is less than or equal to the Maximum Dollar Amount, the service(s) are covered by the authorization. If the cost of the service(s) is greater than the Maximum Dollar Amount, the service(s) may not all be covered by the authorization.
    • Selecting Check For Available Units compares the number of units of the service(s) rendered against the number of Maximum Units 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 Maximum Units, the service(s) is covered by the authorization. If the cost of the service(s) is greater than the number of Maximum Units, the service(s) may not all be covered by the authorization.
    • Selecting Check For Available Visits compares the number of visits of the service(s) rendered against the Maximum Visits amount 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 Maximum Visits, the service(s) is covered by the authorization. If the cost of the service(s) is greater than the number of Maximum Visits, the service(s) may not all be covered by the authorization.
  3. For the Verification Level for Authorizations, 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 to set these fields to Warn User if the 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 to use Report As Error And Include On Bill so that claims can be sent and meet timely filing standards. 
  5. 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 on the Managed Care Authorizations form.
    For the Authorization Group, select the group(s) to apply to this guarantor authorization. This value auto-populates the preselected service codes from the Authorization Group as defined in Authorization Group Definition.
    Note: 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 is limited to the selections made here based on the guarantor. If no selections are made for a guarantor, the Authorization Group drop-down include all authorization groups. 
  7. The Authorization Group Information window displays all previously associated authorization information for the guarantor.
  8. For Select Authorization Item, choose a line item from the Authorization Information window to edit or delete.
  9. For the Effective Date, enter the first day this authorization will be active.
  10. For the Expiration Date, enter the last day this authorization will be active.
  11. Select the Authorization Group to apply to this guarantor authorization.
  12. Select all Service Code(s) to apply to this authorization. The values in this field are filtered based on the  Authorization Group selected.
  13. For Require Authorization, select whether to require an authorization for the selected service code(s).
    • If Yes, select whether to require a value for Require Authorization Number. The Netsmart best practice recommendation is to require the authorization number when entering authorizations. There may be instances where the authorization number should not be required (for example, when entering an authorization to track utilization). If Require Authorization Number is set to No, an authorization that does not include an Authorization Number can cover the services.
  14. Select Update to save the configuration for this authorization information.
  15. Select Delete to remove this authorization information.
    Result: The saved changes or removals are filed.
► See Also
► SQL Tables
  • SYSTEM.billing_guar_table
  • SYSTEM.billing_guar_auth_table