Prior authorization is the process used by insurance companies to determine whether a medical service, procedure, or prescription drug will be covered under a patient's insurance plan. If the coverage has been approved, the insurance company will provide a prior authorization number. This number is used to confirm that the service or procedure has been approved and will be covered by the insurance company.
In this article you'll learn about:
- What is a prior authorization number
- How to add a prior authorization number for patient
- How to edit a prior authorization number
- How to manage prior authorization number
- How to view associated bills in the authorization details
What is a Prior Authorization number
A prior authorization number is a unique identifier assigned by an insurance company as approval of coverage for a specific medical service, procedure, or prescription drug. This number serves as proof that the service or procedure has been approved and will be covered by the insurance company when the claim is submitted.
A prior authorization number is also an important tool used by insurance companies to approve coverage for medical services, procedures, and prescription drugs. By understanding the prior authorization process and obtaining a prior authorization number, you can ensure that your medical needs are covered and avoid unexpected out-of-pocket costs.
How to Add a Prior Authorization Number
To add a prior authorization number within the RCM:
1) Open the needed patient profile and find the insurance
2) If exist, select the insurance company you want to link the prior authorization number or create a new one:
3) In the opened window scroll down to find Authorizations
4) Press Add Authorization
5) Fill in the required fields
Note: You are able to upload document with granted Prior Authorization Number to have a chance to check the initial document if needed.
6) Press Create
Prior authorization numbers will be visible under the patient's insurance information in the RCM.
How to Edit a Prior Authorization Number
To edit a prior authorization number:
1) Open the desired Patient and find the insurance
2) Select the insurance policy of the related prior authorization number
3) Scroll down to see the list of prior authorization numbers
4) Open the one you want to edit
5) Click the button Edit
6) Make necessary changes and press Save
How to Use a Prior Authorization Number in the Bill
You can link the prior authorization number to a bill to further use it for claim submission.
1) Open the desired bill, choose a charge item you need to work on, and click on it
2) Scroll down to the Bill Details and click on Edit
3) Сhoose from the drop-down box with the Prior Authorization Number the relevant one. Then hit Save
Once saved, you'll be able to see the linked prior authorization number in your bill. It can be used for claim submission.
Note: if you're not able to see the relevant Prior Authorization Number and its details, you can add a custom Prior Authorization Number. Though it will only exist in the Bill.
Just type your number in the Prior Authorization Number drop-down box, click on + Add [number] as a custom item and Save.
How to Manage Prior Authorization Number in the Claim
When the prior authorization number is added to the bill it will be auto-populated in the claim. In this case, when you submit the claim it will include the related prior authorization number.
To submit a claim with the authorization number selected in the bill, click on Create Claim.
Once the claim is created scroll down to the Appointment Details to see the prior authorization number.
The prior authorization number linked to the bill will be visible in the Appointment Details of your claim.
IMPORTANT: if you've changed the initial prior authorization number in the bill to which a claim has already been created, Void the Claim and create a new one.
Once a prior authorization number is linked to a bill, the system will track these changes and update the number of left visits across the system instantly (no need to refresh the Appointment page):
- in the Appointment:
- inside Insurance information in the Patient Profile:
How to View Associated Bills in the Authorization Details
Whenever a prior authorization number was linked to a bill, you can see in one place both the authorization details and the list of bills associated with them.
To view the list of linked bills:
1) In Patients tab, open Patient profile either from the list or by starting typing their name in the search box. Then click on the Patient's name
2) In the opened window choose Insurance in the left-hand menu and select the needed insurance
3) Scroll down to the Authorizations
3) In the Authorizations section you can see bills id are linked to which authorizations. Locate the desired Authorization # and click on it to view the full details
4) Scroll down the page to get more insight into the bills associated with the chosen authorization
In this section you can see linked bills with the following info to view at a glance what is going on with them:
- bill ID
- date of service
- location
- status
- label
You can also open the bill to view full details from here:
1) Press on the Bill ID
2) You are redirected to the Bill Details