Copy Of Entering Authorizations

1. Navigate to the authorizations section of the client's profile then select the Add Authorization+ button 

• Client must have a funder with service line added
• For insurance type funders, a diagnosis is also required.

Yes:

• Used when an authorization has been received.

Pending:

• Used when you are waiting to receive an authorization but need to schedule appointments.

Not Needed:

• Used when a funder does not require an authorization.

• By default when adding an Authorization our system will consider an "Authorization as Received" which is defined as "Yes"
• If you are "waiting to receive an authorization" but need to schedule appointments you can mark as "Pending"
  • Authorizations marked as 'pending' allow scheduling to occur against the auth, but the appointments on the scheduler will display in Orange to indicate the pending status. 
  • Appointments completed with a pending auth will also show on the Billing report with this Pending status in the Validation column:
  • Once the client's authorization is updated to 'yes' for received, then all of the appointments will update to green in color on the scheduler and there will no longer be the validation warning in the Billing Export.  
• If your funder does not require an authorization; you can mark it as "Not Needed"

  • Tip: Although a funder may not require an authorization, it is important you have a way to track treatment utilization to ensure the client is receiving the recommended number of treatment hours set by your clinicians.

Type in the Authorization Number 

• If an authorization is Pending: Type in the pending authorization number or a placeholder
• If an authorization is Not Needed: Type in something such as "Not Needed"
  • It is not recommended to input a fake number or "N/A" as you could see issues later with billing 

Enter the Start and End Date range of the authorization 

• If an authorization is Pending: You can input the dates requested from the funder
• If an authorization is Not Needed: You can input dates for a recommended re-evaluation, for example.

Select the Rendering Provider

• Agency: Will generate only group information in columns AP - AS of the billing export report
• Provider Assigned to the Appointment: Will list the provider who physically performed that service during that session. 
• The name of the supervising BCBA: Will list the selected BCBA as the rendering provider despite if another employee performed the service.

Optional: Referring Provider

• If a referring provider is required to be submitted on box 17 of the CMS-1500 form for claims, they can be listed here. 

• The Funder, Service Line and Diagnosis will auto populate. 
  • If you do not see the Diagnosis then you will need to go back into the client profile and enter one
• Rendering Provider selection will be dependent on your funder billing requirements outlined in your funder contracts.
• For a referring provider to populate in the drop-down options, they will first need to be added to the client profile under the Referring Provider tab.

• By Service:
  • Used if you receive an authorization that puts parameters around how many units can be used per billing code.
• By Authorization: 
  • Used if you received a lump sum Authorization that does not specify hours by service. You will be prompted to enter the Total # of units for all services.

• It is recommended to know what your Funder Scheduling Rules are for  "Appointment Exceeds Authorized Hours". If your company has selected "Do Not Allow"  then users will not be able to schedule more than the authorized units available.

• Tip: If you want to have more control over preventing staff from scheduling more hours than allowed/needed, then it would be recommended to Distribute Units By Service and enter in the Authorized Units. 

• Add multiple services to the same authorization by clicking Add Service to add individually, or Add All Services to add all service names under the client's funder
• Optional: The Scheduling Goal allows you to target a specific intensity of service that is different from what has been authorized. For example, if the family does not accept all of the authorized hours

• The system will not allow users to schedule more than is authorized as long as you have set the Exceed Authorized Hours Scheduling Rule in your Company Settings to "Do Not Allow".

• Please note:  When viewing the authorization details from the client authorization home page the system displays the amount in "hours".

  However the system is still calculating the units and displays units in the billing reports. 

• Please note: When viewing the authorization details from the client authorization home page the system displays the amount in "hours".
  • However the system is still calculating the units and displays units in the billing reports.

• The system will not allow you to end date the authorization if future appointments exist for this authorization nor will you be able to reduce the units below what is already scheduled: