You can create authorizations for standalone services using the Service Rate functionality on the patient treatment episode. This allows the authorization number to be added to claims for the selected service.
Note: Standalone Services are those created with the Attendance Calendar - Requires Utilization Plan or Service Rate toggle disabled.
Create a Standalone Authorization
Use the following steps to create an authorization or a standalone service.
- Open the patient record.
- Click on Treatment Episodes and select the episode that you'd like to add the authorization to.
- Open the Scheduling and Utilization tab and choose Service Rates.
- Click Add Service Rate.
- Complete the Add Service Rate fields.
- Select Standalone Authorization from the Service Rate Type drop-down.
- Start Date: Enter the date when the Standalone Authorization starts. This is the first date the authorization can be applied to a date of service.
- End Date: Enter the authorization's end date.
- Facility: Set the facility. This determines which services are available.
- Service: Select the standalone service that requires authorization.
- Payer: Select the Payer from the list of insurances added to the treatment episode.
- Choose the Authorization Status:
- Authorized: The payer has approved the medical necessity of the treatment being requested and provided an authorization number.
- Denied: The payer has denied the medical necessity of the treatment being requested.
- Not Required: The payer does not review for medical necessity for this level of care. Treatments do not require authorization and the patient will receive benefits for this treatment based on medical necessity. The payer may request medical records at a later date to investigate the medical necessity of the treatment.
- Pending: A placeholder status that is used while waiting to hear back from the care manager about approval or denial of the requested treatment. Important: Claims cannot be submitted while the authorization is in this status.
- Required – Not Obtained: This is used when authorization has never been obtained. The medical necessity can be appealed at any time.
- If the status is Approved, enter the Authorization Number.
- Enter the number of Units authorized.
- Note: This number does not control how many units can be billed, provided all units fall within the specified date range of the authorization.
- Click Add.
- Once the Standalone Service is added to the Attendance calendar, submitted, and the claim is created, the Authorization Number will be added to the claim. You can preview the claim to view the authorization number.