Claim Form Rule: Adding or Removing Prior Authorization Number

  • Updated

What claim change is needed?

Adding a prior authorization number to a CMS-1500.

Box Number

UB-04: n/a

CMS-1500: Box 23 - Prior Authorization Number

Steps

For U/R-Required Services

  1. Create a U/R plan for authorized dates. 
  2. Mark the Authorization Status as Authorized. 
  3. Enter authorization number.
  4. In Management Center > Claim Rules, select Create Claim Form Rule.
  5. Select Practice.
  6. Name the rule.
  7. Set claim rule conditions.
  8. Select Claim Type: Professional. 
  9. Select behavior "Facility - CLIA Number". 
  10. Click Add.
  11. Choose between options "Authorization - Require and Write to Claim" and "Authorization - Write if Present."
    mceclip0.png
  12. Click Create.

For Standalone Services

Authorization for standalone services can only be added via Combined Service Sets.

  1. Create a Combined Service Set.
  2. In Practice Admin > Admin, toggle settings for:
    • Allow Authorization Number in Standalone Services
    • Combine Standalone Services on Claim Form
  3. In Attendance, click "Select Combined Service Set."
    mceclip1.png
  4. Select the authorization status and enter the authorization number.
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  5. Click Save.
  6. In Management Center > Claim Rules, select Create Claim Form Rule.
  7. Select Practice.
  8. Name the rule.
  9. Set claim rule conditions.
  10. Select Claim Type: Professional. 
  11. Select behavior "Facility - CLIA Number". 
  12. Click Add.
  13. Choose between options "Authorization - Require and Write to Claim" and "Authorization - Write if Present."
    mceclip0.png
  14. Click Create.

Related Articles

To read more about how to set claim rule conditions and order, see the Claim Rule: Setting Claim Rule Conditions article.

To read more about how to set up a claim rule to be effective as of a certain date, see the Scheduled Change Sets article.

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