QDPM - Authorization

QDPM - Authorization

Authorization 

How do I add an Authorization 

  • Click 'Add Authorization' on the Case


  • Authorization number displays in HCFA Box 23  and 2300 electronic ANSI
  • Add limiting factors and trigger Alerts for Scheduling and Charge Entry, by entering any of the following: Effective/Expiration Dates, # of Visits, Dollars, Days or Units, CPT Code(s)
  • Authorizer is a free form field for name, contact for Authorization 
  • Note: displays in the Authorization drop down



To a Charge

To add an Authorization to the Charge 'on the fly': Use the 'Authorization' drop-down > 'Add Manually'.  

  • 'Add New' is ONLY for adding an authorization to an existing Case 




How do use a Visit countdown on an Authorization?

  • Add a Case
  • Add an Authorization to the case with the Visit field filled in > SAVE


The Visit Counts will appear when the Case/Authorization are chosen when creating an Appointment


The Visit Counts will appear when the Case/Authorization are chosen when entering a Charge




What happens when we run out of authorized visits? 

  • The system generates a red visit note, to indicate there are no remaining visits
  • If you try to save you will receive a Validation Error 



If you need to save the appointment without authorized visits:

  • Close the validation popup 
  • Simply toggle the Authorization field to 'Select' or 'Add New' 


You will received this same validation error if you try to save a Charge on an authorization whose visits are all used up



How should I use the Authorization section if there is no Authorization number?

Leave the Authorization Field(s) blank. If a note is put in the Authorization number field(s) the claims will reject.


In this screenshot we are using the Authorization for the purpose of adding a note that alerts charge entry no Authorization is needed.  We are presented with a yellow validation warning we click [save & continue].


Now in the charge entry and the scheduler the verbiage is ****Pending*** and in a drop down we can see the note entered or for the visit countdown the banner will appear with the countdown. 



What does the Validation Error 'At least one of the authorized CPT must be on the charge' mean?

This indicates to the charge entry person that there is a limitation set on the Authorization.  You may use the 'Authorization' drop down to choose select to decouple this charge from the Authorization or you may choose to hold the claim until you verify the CPT you have or you may clear the CPT's listed.