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Insurance Authorization

 

 

Axxess’ innovative approach to adding and managing insurance authorization for patients is a comprehensive authorization management tracking tool which associates authorizations to scheduled visits. AgencyCore will trigger warnings when scheduled tasks exceed the number of visits/units authorized.

 

Insurance Profile


View Lists Insurances / PayorsBegin by reviewing and updating the insurance profile through the View tab, hover over Lists and choose Insurances/Payors.

 

Find the Insurance name that requires authorization, and the select Edit.

 

Edit Payors

 

In the Insurance / Payor Details section ensure the radio button for Yes is chosen for Visit Authorization Required.

 

Edit Managed Care Payor

 

Choose the type of authorization for the insurance:

 

After adding the Authorization type, navigate through all 4 steps and click Close.

 

Edit Payor Step 1

 

Edit Payor Step 2

 

Step 3

 

Close

 

Tip: Some insurances only authorize a set number of visits with no date ranges, others with authorize for a certain date range only.  The authorization is always up to the discretion of the insurance company; always verify accordingly.

 

 

Add Authorization to Patient


Patient ChartsYou can add new authorization for a patient in the Patient Chart. Open the Patient Charts by toggling over Patients and choosing Patient Charts. Search for and select the patient for which you wish to add authorization.

 

In the Patient Chart, select New Authorization in the navigation bar.

 

New Authorization

 

Fill out the form and be sure to enter the authorized dates/units and add authorized disciplines.

 

New Insurance Authorization

 

Add in comments for the authorization, attach related documents, and select Save.

 

Save Insurance Authorization

 

Note: If the patient’s insurance does not require authorization you will receive a notification such as below.  The insurance should be verified in the patient’s profile to proceed.

 

No required Authorization

 

 

Verify Authorization


In the Patient Chart, select Schedule Activity.

 

Schedule Activity

 

Click the down arrow next to Actions and choose Manage Episode.

 

Manage Episode

 

Verify and update the Primary Insurance and Visit Authorization Required sections. Save.

 

Edit Episode

 

 

Update Insurance Demographics


Edit PatientTo update a patient’s insurance demographics select [Edit] on the patient’s chart.

 

Here is where you can update the Payment Source information. Be sure to verify the Payment Source selected matches the  Insurances Profile information.

 

Payment Source

 

Insurance Payor Info

 

 

Schedule Authorized Visits


In the Patient Chart, select Schedule Activity.

 

Schedule Activity

 

In the Schedule Activity, choose the date your authorized visit will take place. Use the Scheduler to identify the task and user and click Save.

 

Show Scheduler

 

Warning NotificationIn the top right corner of your screen, a warning may show for unauthorized visits. This warning will disappear once you authorize your task. To authorize your task, see Task Not Authorized section below in the Help Center.

 

Authorize multiple tasks at one time. Select Edit on the right for the appropriate authorization.

 

 

Edit Authorization

Once in the edit screen, scroll down, select Show Unauthorized Visits.

 

Show Unauthorized Visits

 

Select the visits to attach to the authorization and click Authorize.

 

Unauthorized Visits List

 

Verify all authorized visits are included and click Save.

 

Save

 

Tip: Select Refresh under Actions in the Schedule Center to show updates to the patient’s schedule.

 

Refresh

 

 

Task Not Authorized


Visit Not Authorized NotificationIn the Schedule Activity view under the Patient Chart, a warning symbol will show on the left side of the task if it is not in the correct authorization range!

 

Grant AuthorizationClick on the warning symbol to view and attach to a new authorization.

 

 

After the visits have been attached to an Authorization the Warning will go away!

 

 

 

 

No Warning

Note: A new authorization must be added before the scheduled visit task can be attached.

 

Grant Authorization

 

 

View and Add Authorizations


In the Schedule Center, select Authorizations in the top navigation bar.

 

Authorizations

 

To add a new authorization, select Add Authorization in the top left. To edit an existing authorization, select Edit on the right.

 

Authorization List

 

Visit Warning NotificationAfter adding / updating the authorization, the visit can now be linked to the appropriate authorization. Click on the warning symbol to view and attach to a new authorization.

 

Grant Authorization

 

No WarningAfter the visits have been attached to an Authorization the Warning will go away!

 

 

Authorization Report


Report CenterView the Authorization Report in the Reports Center located under Reports.

 

Scroll down to the Schedule Reports located in the middle column at the bottom. Choose Authorization Utilization.

 

Schedule Reports

 

Fill in the report criteria and select Generate Report.

 

Report Center - Generate Report

 

NoteA user must have permission to Schedule Visits/Activities in order to add/view Authorizations.

 

Index