Insurance Authorizations

 

ClinicTracker tracks insurance authorizations for those payors that require them prior to service delivery. You can access the Insurance Authorization form from the Patient Contacts Actions menu, the Financial tab of the Demographics module, and the Appointments tab.

 

 

The Insurance Authorizations form contains the following fields:

 

FIELD NAME

FIELD DESCRIPTION

1. Payor

 

 The dropdown lists the insurers recorded in the patients' insurance tab of the Demographic record.  Select the payor who has granted the authorization.  

2. Start Date  / End Date

 

Enter a date range for which the authorized visits are valid.

 

3. Authorization Code

 

Enter the specific reference number the payor provided. 

 

4. Revision Number

 

In certain circumstances, the payor re-uses authorization codes. However, it is still important to track the different versions because they may have distinct authorized date ranges or other restrictions. The revision number allows you to distinguish between two authorizations with the same code. By default, all authorizations will start at revision #1.

 

5. Auth Number of Sessions

 

Enter the number of sessions allotted for the given authorization code. The system automatically updates how many session were used and the number that still remain. If the authorization isn’t for a set number of sessions, check the N/A box.

 

6. Auth Duration (in hours)

 

Enter the number of hours allotted for the given authorization code. The hours used and remaining will update automatically. If the authorization isn’t for a set number of hours, check the N/A box.

 

7. Auth Days

 

Enter the number of days allotted for the given authorization code. The number used and remaining will update automatically. If the authorization isn’t for a set number of days, check the N/A box.

 

8. Auth Claims

 

Enter the number of claims allotted for the given authorization code. The number used and remaining will update automatically. If the authorization isn’t for a set number of claims, check the N/A box.

 

9. Auth Allowed Amount ($)

 

Enter the dollar amount allotted for the given authorization code. The dollars used and remaining will update automatically based on the allowed amount from the fee schedule. This allowed amount can be viewed and adjusted from the Claim Detail form. If the authorization isn’t for a set amount, check the N/A box.

 

10. Allow to Lapse

 

Check this box if you do not want the system to notify you when the number of visits or duration are coming to an end according to the various authorization reports.

 

11. Services

 

The box on the left consists of a list of available services. Place a checkbox next to each authorized service. The selected items will be displayed in the list on the right.

 

If the authorization code isn’t for a specific service or set of services, leave this box empty.

 

By clicking the wand icon, you can select a group of services by choosing a Service Category. For more information about configuring these categories, click here.

 

12. Authorized Clinician

 

If the authorization is valid only for a certain clinician, select that name from this list. Otherwise, indicate that the authorization is valid for any clinician.

 

13. Notes

 

A free-text section for any additional notes.

 
14. Hide "Allowed to Lapse" Check this option to prevent records with "Allow to Lapse" (#10) selected from displaying in the list of authorizations.
15. Color Key See below 
16. Select Authorization Package  Choose from Select Authorization Package or Select Master Authorization Package. For more information, please see: Insurance Authorization Package Input and  Insurance Authorization Package Master Input
17. Clinician Choose a clinician from the drop down list to associate with this authorization. 
18. View Linked Appointments Click here to view a list of appointments with the same authorization code. 

 

All existing authorizations will be displayed in a list on the bottom of the form. The list will be color coded as follows:

 

  • Blue items -- authorizations that are still valid (sessions/time remaining and not expired)
  • Red items -- authorizations that have lapsed (no sessions / no time remaining or expired)
  • Orange items -- authorizations that are nearing expiration (sessions/time remaining and not expired)
  • Black item -- authorizations that have lapsed, but you have indicated do not need to be renewed by checking the Allow to Lapse checkbox.

 

Clicking the eye icon will display all appointments recorded with the current authorization code.

 

Reporting

You can run a report that will display the same type of information displayed in the list on the bottom of the Insurance Authorization form for the currently selected patient. To do so, click the Report button in the middle of the form and select ‘Full Patient History.’ You will be presented with the same options you can also find by going to: Reports -> Admin -> Insurance Authorizations, but the report will only display information for the current patient. To get a detailed report of only the currently loaded authorization (including the notes field), click the Report button and select ‘Individual Authorization Detail.

 

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