Member Service Authorization Section

Enter member service authorization information.

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   Go to: Avatar MSO > System Maintenance > Budget Tracking Account Setup > Member Service Authorization Section
2. In the Select Member field, enter the member name.
3. In the Authorization field, select an authorization from the list or select Create New to set up a new authorization.
   • Select Save Authorization to save the authorization information entered in this form.
   • Select Delete Authorization to delete the selected authorization.
4. Select the Brief Member Review button to view a summary report for the selected member.
5. Select the Member Authorization History button to view a report containing the member's authorization history.
6. In the Type of Authorization field, select the type of authorization from the drop-down list.
7. In the Funding Source Authorization is For field, select the provider.
8. In the Benefit Plan field, select the plan from the drop-down list.
9. In the Performing Provider field, select the provider from the list.
10. In the Performing Provider Type field, indicate the provider's designation.
11. In the Planned Admit Date field, enter the client's admission date.
12. In the Authorized Level of Care field, choose the level of care being authorized.
13. In the Current Authorization Status field, indicate the status of the authorization (Authorized, Denied, or Pending).
14. In the Current Authorization Status Reason field, indicate the reason the authorization status is either Denied or Pending.
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 Contracting Provider Authorization field, select the authorization from the list. This field is filtered by the Provide To Be Authorized, Begin Date Of Authorization, and End Date Of Authorization fields. This field is disabled if no authorizations match the filtering criteria or if the selected Funding Source Authorization Is For has Contracting Provider Service Authorizations Contain Dollar Limitations set to No.
18. In the Next Review Date field, enter the next date on which the authorization will be reviewed.
19. 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.
20. In the Authorization Grouping field, select the grouping the authorization belongs to.
21. 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.
22. In the Letter Type field, select the letter type from the drop-down list.
23. In the Procedure Code Type fields, indicate whether the procedure code is a CPT Code or a Revenue Code.
24. In the Code Authorized fields, choose the codes for the authorized procedure from the list.
25. In the Units Authorized fields, enter the number of units that have been authorized.
    • The Estimated Liability Code fields are display-only, and shows the related liability code.
    • Continue filling out the subsequent fields on the form for any additional procedure codes.
26. 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.
27. In the Secondary Diagnosis Authorized field, enter the secondary diagnosis or diagnosis code.
28. In the Comments on Authorization field, enter any comments pertaining to the authorization.
29. In the Internal Comments field, enter any comments for internal use. These comments will not display in claims processing forms.
30. In the Inhibit Adjudication for Services... field:
    • Select Funding Source Authorization to inhibit adjudication for funding source authorizations.
    • Select Contracting Provider Service Authorization to inhibit adjudication for contracting provider service authorizations.
    • Select Member Service Authorization to inhibit adjudication for member service authorizations.
31. In the Claim Status for Inhibited Services field, choose the claim status to be associated with services that are inhibited.
32. In the Claim Status Reason for Inhibited Services field, select the reason code for denied or pending inhibited services.

► Registry Settings

• Enable Authorization Frequencies