Service Details (Billing Authorizations)

Details

You can enter multiple entries if authorizing multiple services. In addition, these setups allow you to override the contract rate if the payer authorizes the change. Over time, this form also displays the amount of units and amounts used, units left, and claims tied to the service detail authorization.

Service detail records allow for units of service. If a max amount of unit is defined on the Billing Authorization Header, the system will honor that amount first. For example, if you enter 200 max units on the header, and enter 100 units for 3 service detail records, the system will stop using all detail records once the 200 max is reached.

See Authorization Details - Client/Finance Bills, Authorization Information tab

• Service/Rate  Here you select the appropriate program + service rate line defined for this funder that you previously setup in the plan/contract setups.
• Approved -  If a claim is produced (See Authorization setup on the Plan/Contract Rates Setup for rules of producing the claims with the plan/contract authorization flags), it will not be released to the funder until this is checked
• Date From and Date To.- The date range this service authorization covers
• Diagnosis Code - If entered, will be passed in 837 file.
• Units Of Service - Total units covered in this period for this service in this program for this funder.  See unit’s explanation in rate setups for what represents a unit. I.e. monthly, daily, bi-monthly, time chart based.
• Used - Sub report displaying the Amount and Units used, and the Units Left.
• Override Information - As you learned in the Billing Rate Setups that were applied to Plans/Contracts, within the history contained the plans that use a rate, the logic/rate methodology being used and the procedure codes being used.   In this area you can choose to override that logic with any procedure code and amounts you so choose.  As long as the rate methodology defined on the rate will be the same.  I.e.:  the rate methodology in the history was a monthly rate; the override must be a monthly rate. So here you have the ability to enter rates per client per service or what we refer to as an override rate.
  • Procedure Code - Choose the appropriate procedure code. It can be the same as on the associated contract or a different one.
  • Amount Charged - The amount charged different from the contract rate. Some agencies use 0 if only needing to report claims with no amounts.
  • Copay Amount - Ability to apply co-pay deductions on authorizations by the service.
• Claims generated -Sub report listing all claims that used this Service Detail entry.