 | NOTE: Authorization is sometimes abbreviated in BestNotes as "Auth". |
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Prior Auth: A certification or authorization that an insurer provides prior to medical service occurring. Obtaining an Auth means that the insurer is obligated to pay for the service, assuming it matches what was authorized.
Prior Auths provide companies a way to ensure that they will be compensated for the services they provide to their patients. Auths are procured prior to services being rendered. Services are authorized against a fixed set of procedures and are generally time bound. “Open Authorizations” exist specifying that a patient is authorized for any number of procedures during the Open Auth time period.
To help facilitate effective management of Prior Auths for customers, the BestNotes Prior Auths module has been designed to allow staff to:
- Input Auth information for patients prior to services being rendered
- Create Auth templates in an effort to streamline data entry and help prevent input errors
- Track and monitor usage of services rendered against a patient's Auths
Payers
Payer information will still appear in the Episode tab but has been placed into it's own sub-tab therein:
If there are no Payers entered for this patient, this sub-tab will have a Cash Only check box
- The Payer field is an auto-complete that pulls from a list of payers within your agency's database. For more information, Click HERE.
- Subscriber Detail Section:
- If "Child" is the Relationship, a new Subscriber name field displays and is a search engine for all of your BestNotes contacts.
- Co-pay is only a placeholder and has no features in BestNotes.
- Member ID is required to save.
After entering the details regarding this payer/subscriber, a new view will be presented:
- Multiple payers (with details), can be seen from this same view (only one payer's details will be visible at a time).
- Note that within BestNotes, the Payers module has been implemented in other areas as well (Billing and Labs); this updated view should make it easier for agencies using any of these modules to maintain and manage Payer information.
Authorizations
The Auth entry form allows agency staff to collect all of the details necessary to effectively administer Auths including:
- Auth # (number, from Payer)
- Units authorized / Open Auth status
- Auth Length
- Auth Dollar Limit
- Auth Start / End (Stop) Date
- Auth Codes (See Codes below first)
- Additional notes and details regarding the Auth
Several helpful mechanisms have been put in place to help ensure accurate entry of information:
- The form fields have been programmed 'smartly' to lead each other when possible (e.g. Auth Length will update the Stop Date, Open Auth negates the Days / Units options, etc.)
- The code search is an auto-complete that is fed from the agency's own register data (discussed below)
- Date-Picker (calendar) entry is enforced for the date-type fields
Saving the Auth allows it be viewed from the Payers sub-tab and service codes to begin being associated with it.
Each Auth listing contains relevant details about the Auth along with a quick status indicator icon:
- The Auth is "Active" and services can be associated with it
- The Auth has been marked "Inactive" by staff; services cannot be tied to it
- The Auth has been "Expired" for one or more reasons; No more services/dollars
available or the authorization's end date has passed.
Auth Templates
Auth Templates provide a quick way for staff to fill in the relevant details about an Auth when the same service Auths are frequently repeated. Checking the “Template” box allows the staff to fill in a name for that template and will tell BestNotes to store the details surrounding the Auth as a template. The template can then be selected from the “Template” option box at the top of the Auth form for the details of the Auth to be automatically filled in.
Details stored in an Auth Template include:
- Number of Units
- Unit Type (units/days or Open Auth)
- Auth Length / Auth Length Unit
- Dollar Limit
Codes within a “Clinical Codes” category will have an option of 2 separate codes used to describe that entry: Office Code and Procedural Code. The Procedural Code will be the code that is used to determine authorized services and usage toward the authorizations.
Having two sets of codes will allow agencies to continue to track services and appointments using their own systems while having an additional “official” code mapped to the services rendered.
The Procedural Code values will be used to populate the auto-complete in the Auth form and as the unit codes when calculating authorization usage.
When a rendered service is added to the BestNotes Register/Ledger for a patient, the code for that service is examined to determine if it is a member of a “Procedural Code” category. If so, a list of that patient's authorizations is generated then examined to verify if an Active Auth exists for that code.
If an appropriate Auth is found, the Register/Ledger entry is tied to that authorization. The Auth's usage is recalculated with the values from the new Register/Ledger entry.
If a suitable Auth for the supplied Register code is not found, the user is alerted that they are entering services that do not have a corresponding Auth form.
Register/Ledger entries that have been tied to an authorization will be highlighted green in the register:
Authorizations will NOT be used, counted, or tracked if a Payer is made inactive in a client payers tab or in Settings.
Contact Reporting and Reconciliation
Auth reporting is available from the contact Payers screen by clicking the reporting icon at the top of that frame. This will bring up the “Authorizations Reconciliation Report" for that client (in a new window):
This report offers two distinct views: Matched and Unmatched Services.
Unmatched Services
This view allows users to see services rendered that were unable to be associated with an Auth (and thus the agency potentially will not be paid for the service). When generating the report, the system will examine any Auths that client has that are a potential match for each service and allow the user to select a suitable Auth to match that service. Once selected, the user can click the “Apply” button to tie that service to the selected Auth. If no suitable Auths exist for that service, “No Matching Auths” will be shown instead of the drop-down.
Each time a service is tied to an Auth in this manner, Auth usage must be recalculated based on the values of the new service being tied to it. This can affect the output of the report. If, for example, tying a service to an Auth expires that Auth, it will no longer be available as an option to select for other services.
Only services rendered from one of the “Clinical Code” categories will appear in this report.
Matched Services
This view allows users to see which services have an associated Auth. Only those services which are currently associated with an Auth will appear.
It also allows the user to “break” the link between a service and its Auth by clicking the broken chain icon for that service. This will dissociate the Auth from that service, both freeing up the calculated usage of that service from the Authand adding the service to the Unmatched Services report.
The default timeframe for both reports is the immediately preceding 7 days.
Agency Reporting and Reconciliation
Reporting on Auths isn't limited to a single contact at any time. If the agency is using the Auths system, it will have access to the agency-wide “Payers/Authorizations Report” from the Report Type select box in the main BestNotes reporting section.
Again, these reports open in a new window to allow the user to navigate to the various areas of BestNotes where Auths will be in use while keeping the contents of the report in view at the same time.
To help ease reconciliation processes, a link to a client's page is available from the agency reporting aspect:
Clicking this arrow will open that contact's page in the main BestNotes window while keeping the Auth Reporting window in full view.
The agency reporting aspect contains the following reports:
Payers Report
The Payers Report is intended to show the payer status of current / active clients and offers the following views:
Active Clients with Payers:
Shows active, admitted clients who have entries in the Payers table.
Active Clients with Payers without Active Authorizations:
Shows active, admitted clients who have payers, but who do not have any current, active Auths. Clients will appear here who do not have any Auths entered into the system, or who may have Auth that have expired or been inactivated.
Active Clients without Payers:
Shows active, admitted clients who do not have an entry in the Payers table. The active, admitted criteria for these views is defined as clients who haven't been marked as inactive and who have a contact level DOA established but do not have a contact level DOD.
Authorizations Reconciliation Report
This report contains the same criteria and display output as described above, but the scope is expanded to include all contacts in the system.
Again, the default date range for services to appear in these reports is the immediately preceding 7 days.
Authorizations Expiration Report
This report will show all Auths that will expire within the provided constraints. There are currently 2 constraints available:
- Expires within: the time frame for when Auths will expire (defaults to 2 weeks)
- Units Remaining: the number of units remaining for the Auth before it will be expired (defaults to 10)
A third constraint (Dollars Remaining) will be available after Remittance Advice is inserted by BestNotes.
The report display options are utilized as OR modifiers when searching for matching Auths, so provided the defaults, an Auth will appear on the report if the Auth will expire within the next 2 weeks OR the Auth has less than 10 units of service remaining. If Units remaining is provided as a blank value, it will not be factored into the output of the report.
P - Authorization Status Report: displays all clients that are active in a program and group them by program/location.
- It can be filtered by Program and Location (Ctrl+Click for multiple filters).
- This report displays ID, Client Name, Age, Gender, Start Date, Therapist, Payer, Auth Level of Care, Auth Start, Auth End, Auth Number, Reviewer, Auth Notes, Estimated Discharge, Discharge Date & Discharge Reason.
Example: At a glance, this report provides students' Auths that may need follow up.
- Red = the Auth's end date is in the past.
- Green = Auth has not yet expired
- Orange = displays recently discharged (last 7 days) clients
For more documentation on reports, click HERE.