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Contracting Provider Service Authorization Section

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Enter contracting provider service authorization information.

  1. Go to: Avatar MSO > System Maintenance > Budget Tracking Account Setup > Contracting Provider Service Authorization Section
  2. In the Contracting Provider field, enter the contracting provider name or code, and select the provider from the list.
    • If a contracting provider was specified in the Account Budget Management section, this field will be disabled and will display the existing contracting provider.
  3. In the Authorization field, select an authorization from the list or select Create New to set up a new authorization.
    • Select the Save Authorization button to save the authorization information entered in this form.
    • Select the Delete Authorization button to delete the selected authorization.
  4. Select the Brief Budget Contracting Provider Review button to generate a report summarizing the contracting provider's information.
  5. In the Type of Authorization field, select the type of authorization from the drop-down list.
    • Type of Authorization is defined in the Dictionary Update form: Member file - data element 10005.
    • The Authorization Number field is display-only, and shows the automatically generated number for the selected authorization.
  6. In the Funding Source Authorization is For field, select the provider.
  7. In the Benefit Plan field, select the plan from the drop-down list.
  8. In the Performing Provider field, select the provider from the list.
  9. In the Performing Provider Type field, indicate the provider's designation.
  10. In the Authorized Level of Care field, choose the level of care being authorized.
  11. In the Current Authorization Status field, indicate the status of the authorization (Authorized, Denied, or Pending).
  12. In the Current Authorization Status Reason field, indicate the reason the authorization status is either Denied or Pending.
  13. In the Account field, select the account from the list (accounts are created in the Account Budget Management section of this form).
  14. In the Initial or Continuing Authorization field, select whether this authorization is preliminary or continuing.
  15. In the Begin Date of Authorization field, enter the date the authorization begins.
  16. In the End Date of Authorization field, enter the date the authorization ends.
  17. In the Next Review Date field, enter the next date on which the authorization will be reviewed.
  18. In the Authorization Grouping or Individual Authorizations field, indicate whether or not the authorization belongs to a preset grouping.
    • Selecting Individual will disable some of the remaining fields in this section.
  19. In the Authorization Grouping field, select the grouping the authorization belongs to.
  20. Select the Display Authorization Grouping button to display a report for the selected grouping.
    • The Total Estimated Liability field is read-only, and shows the current estimated liability for the procedure based on the information entered on this form.
  21. In the Letter Type field, select the letter type from the drop-down list.
  22. In the 'Procedure Code Type' fields, indicate whether the procedure code is a CPT Code or a Revenue Code.
  23. In the 'Code Authorized' fields, choose the code for the authorized procedure from the list.
  24. In the 'Units Authorized' fields, enter the number of units that have been authorized.
    • The 'Estimated Liability Code' fields are display-only, and show the related liability codes.
    • Continue filling out the subsequent fields on the form for any additional procedure codes.
  25. In the Primary Diagnosis Authorized field, enter the primary diagnosis or diagnosis code for the authorization.
    • If the diagnosis associated with the claimed service is different then the diagnosis on the service authorization, that service will be denied.
  26. In the Secondary Diagnosis Authorized field, enter the secondary diagnosis or diagnosis code.
  27. In the Comments on Authorization field, enter any comments pertaining to the authorization.
  28. In the Internal Comments field, enter any comments for internal use.
    • These comments will not display in claims processing forms.