Insurance Authorization Package Input

[Navigation] Utilities > Insurance Authorization Package Input

[Accordion] Overview

The Insurance Authorization Package Input form allows you to predefine recurring details used in patient insurance authorizations. By creating reusable packages, you can include default values such as the authorization end date, services, authorized units, and other essential information.

When processing a new insurance authorization, selecting a package automatically populates the Insurance Authorization form with all predefined details, which you can review and modify as needed.

[Permissions] The staff member must have Full access to the Maintenance module [Staff > Staff Info > System Permissions > Maintenance]

[Tip] If you see different labels than what is shown in this article (e.g., Patient vs Client), your system may have Custom Labels applied. You can verify and update these by locating "Custom Labels" in the Global Search.

[Accordion] Getting Started

Use this form to set up an Insurance Authorization Package by specifying payor details, coverage type, service categories, allowed sessions or hours, and other limits. These settings help the system manage and enforce authorization rules during scheduling and billing.

Adding a new Insurance Authorization Package

1. Package Name (required): The unique name for the Insurance Authorization Package for easy identification. For example, Standard Outpatient Therapy Authorization.
2. Status (required): Specifies whether the Insurance Authorization Package is Enabled or Disabled. Disabled Insurance Authorization Packages cannot be applied.
3. Description (required): Notes or details describing the Insurance Authorization Package.
4. Payor (required): Select the Insurer from the list of Insurers available in the system.
5. Service Category (required): The type of services covered by the Insurance Authorization Package (e.g., Therapy, Consultation).
6. Program (required): Select the program associated with the Insurance Authorization Package.
7. Place of Service (required): Specify the location that the Insurance Authorization Package applies to.
8. Coverage Type (required): Select whether the services are Covered, Non-Covered, or Bypass.
9. Authorization Code: Optionally enter a common reference number assigned by the payor to track the authorization. Enable the Allow to Lapse option if you don’t want the system to send notifications when the authorized visits or duration are nearing their limit.
10. Start Date (required): The date when the authorization becomes effective.
11. Default End Date (required): Predefined end date for the authorization (after the start of authorization).

12. Number of Sessions (required): Enter the total sessions allowed under this authorization. The system tracks the used and remaining sessions automatically. If sessions are not fixed, check the Formula or the N/A box.

    • Fixed: Use this when the total number of sessions is known. For example, if a patient is always authorized for 6 therapy sessions, click/tap the Fixed radio button and enter the value '6'.
    • Formula: Use this when the number of sessions needs to be calculated dynamically based on specific rules/conditions. Clicking/Tapping on [[img:edit >> lbl:Edit Formula]] allows you to write an SQL expression that automatically determines the session count based on data like start date, end date, or current date. Below is a sample formula using Start Date as an example:
      If the day of the month is less than 25, then output 6
      Otherwise, output the number of remaining days in the month

    CASE 
    WHEN DAY({StartDate}) < 25 THEN 6 
    ELSE DATEDIFF(DAY, {StartDate}, DATEADD(MONTH, DATEDIFF(MONTH, 0, {StartDate}) + 1,0)) - 1 
    END

    • N/A: Select this if the number of sessions is not applicable for the package
13. Number of Hours (required): Total authorized hours for services. Hours used and remaining are updated automatically.
14. Number of Days (required): Total number of days the authorization is valid.
15. Number of Claims (required): The number of claims allowed under this package.
16. Number of Dollars (required): The total allowed amount authorized.
17. [[img:settings>>img:more_vert >> bg:gray]] Maintenance Menu options.
    • Building Input: Manage existing building entries or add a new building input associated with a specific Place of Service
    • Service Category Input: Manage existing Service Categories or create a new Service Category to link all services that belong to it

[Note] You can also access Insurance Authorizations of a patient through the Quick Info (Quick Info >Insurance Auths) and Patient Appointments screens.

[Accordion] FAQs

[Q] Why should I create an Insurance Authorization Package?

[A] Creating a package saves time and reduces data entry errors by storing default values that can be reused when processing new insurance authorizations.

[Q] What information can I include in an Insurance Authorization Package?

[A] You can include details like authorization end dates, default services, authorized units, service types, and other essential authorization fields.

[Q] How does an Insurance Authorization Package help when entering a new authorization?

[A] When you select an Insurance Authorization Package, the Authorization form is automatically populated with all predefined details from the package. You can review and update the information before saving.

[Q] Can I modify the details after selecting an Insurance Authorization Package?

[A] Yes. All prefilled details can be adjusted as needed during the authorization entry process.

[Q] Can I create multiple Insurance Authorization Packages?

[A] Yes. You can create as many Insurance Authorization Packages as needed to support different payers, services, or authorization types.

[Q] Are Insurance Authorization Packages reusable?

[A] Absolutely. Once created, Insurance Authorization Package can be reused for any future authorization entries.

[Accordion] Related Articles

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