Authorizations

The Authorization tile shows the key information of the authorization. You can click on the pencil icon to view the details. 

On the left top corner, it shows the remaining days of the authorization along with the status. 

Adding and Managing Authorizations

Authorizations are a crucial part of managing patient services and ensuring that they are provided within the bounds of approved funding. Once a funding source is added to a patient profile, you can add an authorization associated with it by following these steps:

Add Authorization

• Navigate to the patient profile and locate the funding source to which you want to add an authorization.
• Click on the "Add Authorization" button (plus sign) to begin the process.

Enter Authorization Details

• Authorization ID: Enter the unique identifier for the authorization. This is essential for tracking and claims processing.
• Authorization Range (Start - End Date): Ensure that the authorization dates align with the coverage period specified in the funding source details. The system will prevent the selection of dates outside of this range.
• Service Type: Select the service type from the dropdown. All services with rates assigned under the respective contract for the duration of the authorization will appear for selection.
• Billing Unit: This field will be auto-filled based on the unit selected in the contract's rate screen. However, it can be overridden if necessary.
• Authorization Name: This is an internal name you can assign to the service. It will appear in the scheduler and help with identification but has no downstream impact.
• Allowed Service Locations (Place of Service): Select the locations where services can be provided, such as Home, Clinic, Day Care, Community, School, and Telehealth. These options are pre-configured in the contract’s rate screen but can be edited if needed. Ideally you should specify any restrictions on service locations in the contracts module to ensure compliance during scheduling.
• Max Limits: The Maximum Daily Limits from the contract’s rates section are automatically added here, though you can override them if necessary.
• Min Limits: Set minimum limits if you want to track underutilization in reports. This is optional but useful for setting internal targets.
• Override: If the service name, modifier, or rate differs from what is set in the contract, you can override it for this particular patient. This should only be used in exceptional cases, and generally, updates should be made at the contract level.

Adding Multiple Services:

• You can add multiple services under the same authorization on the same page. Click the "Add Service" button to continue adding services. Ensure all mandatory fields are completed before saving the page. If you add a service section that is not used, it must be deleted to save the page.

Authorization Status:

• Active: Use this status when adding a new authorization.
• Close: Select this status if you want to stop utilizing the authorization before its expiration.
• Expired (Virtual Status): This status is automatically applied to the authorization tile when the expiration date passes.

Tracking and Managing Authorizations

• Service Utilization: Use the system to track authorization utilization directly in the scheduler. This helps ensure that services are provided within the authorized limits and that billing is aligned with the authorization.
• Editing Authorizations: If changes are required after an authorization has been set up, you can edit the details by clicking on the pencil icon associated with the authorization. Remember to save changes after editing.

Temporary Unbillable Authorization

In situations where you need to begin providing services before receiving formal authorization, Motivity allows you to create a temporary unbillable authorization. This feature ensures that services can be scheduled and delivered without delay, while keeping them out of the billing process until the proper authorization is received.

Steps to Create a Temporary Unbillable Authorization:

Add Authorization:

• Navigate to the patient profile and add a new authorization as you normally would. Enter all the required details such as authorization ID (temporary internal name), service type, etc.

Set Authorization as Unbillable:

• In the authorization settings, locate the billable flag and set it to "No" (billable = no). This indicates that while services can be scheduled under this authorization, they will not be included in the billing process.
• This setup allows you to continue providing necessary services without those services appearing in the biller's bucket.

Schedule Services:

• Proceed to add services in the scheduler under this unbillable authorization. The system will allow you to schedule and track these services, but they will remain unbillable until further updates.

Update Authorization Once Received:

• Once the formal authorization is received, return to the authorization details page.
• Enter the correct authorization number and change the billable flag to "Yes" (billable = yes).

Upon updating the authorization to billable, all services provided under this authorization from the first appointment onward will automatically appear in the biller's bucket, ready for processing. You will not need to manually update each appointment linked with this authorization.

Secondary Supplemental Authorization (from secondary payor) 

To schedule an appointment under secondary payor for the patient, please follow these steps:

1. Navigate to the Patient Profile.
2. Select the Funding Sources tab.
3. Click the + button next to the secondary insurance to add the authorization.

When adding authorized services, ensure to:

• Add them as supplemental services.
• Mark the option Allow Scheduling.

Once completed, you should be able to schedule appointments using this authorization in the scheduler. 

 

Copying an Authorization

Copy Button

Location: The Copy button can be found on the header of the authorization page beside the payor name. It is only visible on pages where an authorization has already been saved.

 

Functionality

Initiating the Copy Action:

• Click the Copy button to initiate the process.
• A confirmation pop-up will appear, prompting the user to confirm the action.

Proceeding with the Copy:

• On selecting Proceed in the confirmation pop-up, the system will open a new Add Authorization page.
• This page will have specific fields prefilled with information from the selected authorization.

Prefilled Fields

The following fields will be automatically populated:

• Service Type
• Billing Units
• Place of Service
• Override Details (in expanded form)
• Limits
• Multiple Services/Add Service Sections (if applicable)

Fields Not Prefilled

The following fields must be manually entered by the user:

• Authorization ID
• Authorization Name
• Internal Authorization Number
• Start Date
• End Date
• Auth Status

Note: If any field such as Service Type, Billing Unit, or Place of Service is no longer applicable, the system will leave it blank for the new authorization.

Editing and Saving

Users can review and update any prefilled information before saving the new authorization.

The system performs the same validations and compliance checks as it does for any newly created authorization.

Unique Identification

The new authorization will be saved with a newly generated Internal Authorization Number, ensuring it adheres to the system’s functionality and maintains data integrity.

 

Assign Provider to an authorization

Use this section for easy selection of a provider while adding sessions in the scheduler. If you do not add any provider here then you will have to select from all eligible providers while adding a session in the scheduler. Instead, if you assign a provider here, you will see the assigned provider right away on selection of the authorization while scheduling a session. 

Click on the ‘add’ button to assign a new provider to the authorization.

Criteria for assigning a provider

The eligibility of a provider to be assigned to the authorization for a specific funding source/contract depends on following criteria- 

• Provider should be associated with the service location where patient is assigned.
• Provider should meet all the compliance/Enrollment requirements of the contract for their role (if the requirements are set in the contract)
• Provider should be in network if contact requires them to be enrolled for their role.
• Provider should be active

Removing the Assigned provider

Click on the pencil icon. This will show you a list of all currently assigned providers. Uncheck the providers you do not want to be added here and click on the assign button in the popup to re-assign the correct list of providers.