Case Authorizations

Authorizations are an important part of the business workflow in that they provide confirmation (by insurance companies or individual patient when paying cash) that xyz treatment will be covered (paid for) within the parameters specified. In WellSky Resource Manager, patient authorizations include resource, procedure, date, and visit restrictions for patient treatment. Then as appointments are scheduled, valid authorizations that are defined for resources of the type being scheduled are appear as options within the Edit Appointment screen.

NOTE – If you schedule a patient with resources who are of a type not included in any authorization for the case, none will appear on the Edit Appointment screen.

The Case Authorizations tab is a quick reference and management screen of all the authorizations that have ever been assigned to a given case, listing them by Description, Begin Date, End Date and Status. Use the following discussion to navigate this screen and to manage patient authorizations.

Show Deleted Authorizations: Check this option to refresh the list to include authorizations that have been deleted.

Show Expired Authorizations: Check this option to refresh the list to include authorizations that have expired.

Add Authorizations: Click the New button to add an authorization to the case.

Authorization History: Click the View link to output the authorization history to the screen. Click the Print link to output the authorization history to the selected printer. Note that this applies to individual authorization line item only. Click the Print button to output all the authorizations the patient has.

Edit Authorization: Click the Edit link in the appropriate line item to modify an existing authorization. The Edit Authorization screen will appear.

Delete Authorization: Click the Delete link to remove an authorization from use. You cannot delete authorizations that have been associated with an appointment.

Print: Click the Print button to output a list of the authorizations for the selected patient-domain combinations. Don't confuse this with the History: Print link, which will print the history the individual authorization line item.

Creating an Authorization

See the Add/Edit Authorization Screen topic for a detailed discussion about creating and editing authorizations..

Deleting Authorizations

To delete an authorization:

Locate the authorization on the Authorizations tab of case demographics.
Click Delete in the appropriate line item.
Click Save to commit your changes to case demographics. You will be returned to the Cases tab.
Click Save in patient demographics to commit the changes to the patient record.

NOTE – An authorization cannot be deleted from a patient’s case if it has been associated with an appointment.

Key Considerations

Authorization data entry is governed by the Case Operations Security assigned to the user.
Authorizations use domain rights for scheduling: They are assigned to individual domains and are subject to the user’s security profile for those domains.
Conflict Operations Security determines whether a user can book beyond the authorization parameters (e.g., the visit count or dollar amount). Both the right “Book beyond Authorized Usage” and the right “Book beyond End Visit Date of Authorization” apply.
If the Edit Appointment screen is not configured to appear on Make functions (i.e., the “Use the Edit Appointment Screen when Making Appointments” option is not enabled in the Domain or System preferences), then case information such as Authorizations and Diagnoses will not be assigned to the appointment automatically.
Users can assign Open or Pending authorizations to an appointment.
If you attempt to remove resource types associated with an authorization that has been used, a message that the patient has appointments with a resource type no longer associated with the authorization will appear. You will not be able to complete the modification.