Authorization is the approval of medical services by an insurance company, usually prior to services being rendered.
Auth Tab
Auth Tab has 2 sub-heads:
A. Auth Header
B. Funding Source
A. Auth Header
Below are the Auth Header fields with descriptions:
1. Description - (Enter auth name or a short description)
2. Onset Date - Diagnosis date (Enter *date* in the date format MM/DD/YYYY)
3. Diagnosis - It is the identification of the diagnosis established by the provider. A user can add multiple diagnoses. (By default, the autism diagnosis code is added under Diagnosis 1)
4. Treatment type - It defines the type of provider required. (Select from the drop-down)
5. Auth Status - It allows users to select the current status of the Authorization. (Select from the drop-down)
6. Notes - You may add any relevant additional information that is not covered in the provided fields related to Auth.
7. Referring Physician NPI - NPI is a Health Insurance Portability and Accountability Act (HIPPA) Administrative Simplification Standard. The NPI is the unique identification number for covered healthcare providers. (Enter the NPI number)
8. Referring Physician Name - Defines the provider's name. (Enter the provider's name)
After filling out all the information, click on "Next" and you will reach the Funding Source tab.
Below are the Funding Source fields with descriptions:
1. Funding Source - The name of the organization responsible for funding the sources. (Select from the drop-down)
2. Insurance Id - It is the same ID mentioned in the 'Auth' for insurance. (Enter the Insurance Id)
3. Auth Number - The number is issued by the funding source and can be found in the authorization document (enter a valid 'Auth' number written in the 'Auth' document)
4. Start Date - Defines the start date of the services/ Insurance authorization (Enter *date* in the date format MM/DD/YYYY when the service is set to start)
5. End Date - Defines the end date of the services/ Insurance authorization (Enter *date* in the date format MM/DD/YYYY when the service is expected to end)
6. CMS 11 (Group No.) - (Enter the CMS 11 Group No.)
7. Rendering Supervisor - The rendering supervisor approves sessions that are rendered. (Select the name of the Rendering Supervisor from the drop-down)
8. Auth Type - It defines the type of Auth (Select from the drop-down)
9. Upload Auth - Auth document is the document for approval of medical services issued by an insurance company. (Click on 'Select files' and it will allow you to attach the document which will be uploaded to the system)
10. OOPM, Co Pay, Co Insurance, Deductible - (Enter the amounts)
11. MRN# - Medical Record Number is similar to the insurance ID (Enter the MRN number)
12. CMS 4 - It defines the insured's name (Last name, first name, and middle name)
13. Max by total auth - It defines the maximum as per 'Auth'
14. Max by total auth value (hours) - It defines the maximum 'Auth as per the value.
15. Box 11C - This option appears in the CMS 1500 form.
16. Is Signature Required in CMS Box 13 - (Select yes or no as per the requirement)
17. Acting Supervisor - If the 'Acting Supervisor' option is not selected then the 'Rendering Supervisor' will show in the Client List under the 'Supervisor' column otherwise Action Supervisor will show in the Client List. (select from the drop-down)
After filling out all the mandatory information, click on "Save".