This document covers new features and reports as part of the various authorization workflow events and stages. The changes described below are for non-Medicare patients in the Home Health service line.
1. Obtain Initial Authorization
A. View Authorization Information Notes
If any Authorization Information coordination notes exist, they will be displayed in the coordination notes grid. If none exist, the button will be disabled.
B. Add/Edit Authorizations
If authorization entered is pending, an additional date field to capture ‘Date to Follow Up on Pending Authorization’ will display. This date determines when the stage to ‘Update Pending Authorization with Actual Auth Info’ is generated on workflow.
C. Print Authorization Request
Displays the new Authorization Request Report and can act as a face sheet with common information required by the payor to request authorization. See report examples in Section 4 below.
D. No Authorization Required
The existing feature for ‘No Auth Required’ is still available. Selection of this option is used for scenarios when the payor has no auth restrictions (typically Medicaid payors); the system automatically creates a generic auth so that visits can be scheduled.
E. Authorization Status section
The buttons in this section will be disabled until user exits the Add/Edit Authorizations button. Based on what exists in the authorizations grid, the following occurs:
- If ‘real’ authorization exists (i.e., is not pending), the ‘Authorization Obtained’ button is enabled and ‘Pending Auth Request Submitted’ is disabled. Selecting ‘Authorization Obtained’ ends the stage.
- If pending authorization exists, the ‘Pending Auth Request Submitted’ button is enabled and the ‘Authorization Obtained’ button is disabled. A message reminding the user to update the record with actual authorization info appears and then ends the stage. As described above in Section 1.B, workflow will generate accordingly to ensure that actual authorization gets entered.
- Non-Admit Selecting this option allows the referral to be marked as a non-admit. The reason for non-admission and entry of a coordination note are required. This button is enabled regardless if real or pending auth has been entered in case this option is necessary.
- Authorization DeniedChange Payor Selecting this option first displays a message about what will happen.
If user proceeds, all entries on the Payor Sources tab of the referral form will be removed and the referral will be set back to stage 1 (Process Pending Referral); different payor information can then be entered. In order to retain history of the denied authorization, a new coordination note called “Authorization Denied” will be automatically generated and details inserted into the coordination note itself. This button is enabled regardless if real or pending auth has been entered in case this option is necessary.
2. Obtain Additional Authorization/Reauthorization
A. Authorization can be added/edited as appropriate
If authorization entered is pending, an additional date field to capture ‘Date to Follow Up on Pending Authorization’ will display.
B. Viewing of the episode’s orders and calendar is also an option.
C. Print Supporting Documents
Selected episodic items from the medical record can be printed directly from the screen.
D. Authorization Status Section
The buttons in this section are disabled until the user accesses the Add/Edit Authorizations screen. Based on what exists in the authorizations grid, the following occurs:
- If ‘real’ authorization exists (i.e., non-pending), the Authorization Obtained button is enabled and the Pending Auth Request Submitted button is disabled. Selecting this option ends the stage.
- If pending authorization exists, the Pending Auth Request Submitted button is enabled and the Authorization Obtained button is disabled. Selecting this option ends the stage. The additional stage to ‘Update Pending Auth with Actual Auth Info’ is then generated based on the Follow Up date entered in the authorization.
- The Authorization Denied-Change Payor button is enabled regardless. Previously entered authorization may exist and no new or changed auth may get entered; therefore user may need the ability to change payor.
3. Reauthorization Event
A. Stage 305
Review Declined Reauthorization Request - the old Client Authorizations Report has been replaced with the new Authorization Summary Report.
B. Stage 405
Change Payor and Create New Authorization displays the new Authorization Summary Report and leads user into the Payor Sources tab of the Referral Form in order to add Secondary Payor information as appropriate.