Step 1: Create a Case
Create a new case in the system. This will hold all authorizations and case notes
Step 2: Add a Service Authorization Form
The Service Authorization form is used to add authorized services into the system.
When a Service Authorization is created:
- It becomes available in the system for claim validation.
- If the current date falls between the Start Date and End Date of the authorization, it will appear on the Case Detail page in a grid view.
The Service Authorization grid displays the following information:
- Service
- Provider Name
- Authorized Units
- Quantity Used
- Quantity Remaining
- Start Date
- End Date
If the End Date has passed, the Service Authorization will no longer appear in the grid. However, Case Notes can still be created against that authorization.
Managing Service Authorizations
- If additional units are required for the same date range and same service details, the existing Service Authorization should be edited.
- If the service details or date range differ, a new Service Authorization must be created.
Matching Requirements
For claims to be processed correctly, the following values must match between the Service Authorization and Case Note forms:
- Provider
- Payer / Contract
- Procedure / Service Code