Workflow Authorization Tasks

Authorizations with Appointments Booked Beyond Authorization End Date: Action items will be created for authorizations that (a) have been scheduled within a 14-day period from Today’s date and (b) have been scheduled beyond the authorization End Date or for an authorization that has been closed without a replacement. In making this determination,

• The most recent case is used
• The authorization must be assigned to the appointments: that is, this alert does not report on appointments that do not have an assigned authorization.

Authorizations that Require Re-certification: Action items will be created for authorizations that have Re-certification Due Date occurring within four (4) days of today’s date. The suggested action entails getting the Plan of Care and the supporting documentation sent to the Referring Physician.

Authorizations that Are about to Expire: Action items will be created when the alert threshold that is configured for the given authorization type is met.

The type of authorization is set when the authorization is created. The threshold is used to alert the staff responsible for obtaining authorizations that the patient will need either an extension or a new authorization soon. The idea is the organization will set the threshold to give the appropriate staff the lead time necessary to obtain the update before the patient’s next appointment. In making this determination,

• Action items are created (a) for authorizations about to expire within the next 6 days (b) for those that have met threshold limitations set on the actual authorization (the visits, days, weeks, USD, or procedure).
• The patient must have an active case.
• Action items will be created only for authorizations having at least one approved visit (day, week, USD [dollars], or service).
• Note that an action item will be created even if the authorization is technically expired (i.e., you are past the End Date) if the authorization is left in an Open state and you have appointments scheduled that exceed the number of visits and the warning threshold.

Appointments Booked Using Expired Authorizations: The purpose of this action item is to alert the staff responsible for obtaining authorizations that the patient needs an extension or new authorization before their next appointment. In making this determination,

• The authorization must have expired within the last 30 days, exceeding either the End Date or the remaining visits, days, weeks, USD (dollars).
• The patient must have an active case in the discipline or program matching the authorization.
• The action item will only appear in the list for authorizations having at least one approved visit (day, week, USD, or service)

Overscheduled Authorizations: This alert is intended to inform the appropriate staff that a patient has an authorization that either needs to be extended or a new one obtained.  The criteria for the alert require that  

• Patient has appointments within 30 days of Today's date that exceed the visits authorized.
• The patient has at least one authorized visit within the time frame. This allows the authorizations to be recorded as submitted but not yet approved.
• The alert looks at the most recent case.

Appointments with Pending Authorizations: This alert reports on the authorizations that have a Status of  Pending and that have been scheduled with an appointment. The suggested action for users is to verify that the authorization has indeed been approved and set it to "Open." No other condition needs to be met