Authorizations

Many payers approve therapy in advance: a set number of visits, billing units, hours or dollars, for one discipline, between two dates. The Authorizations tab on a patient's chart keeps each approval, and each request you are waiting on, under the coverage it belongs to.

You need a role that can manage patient authorizations to add, change or delete one. Anyone who can open the chart can see them.

Add an authorization#

1. Open the patient's chart and click the Authorizations tab.
2. Click Add Authorization.
3. Choose the Coverage the payer approved it under and the Discipline it covers. Each coverage shows its dates, so you can tell an old plan from the current one with the same payer. Add the coverage on the Coverage tab first if it is missing (see Insurance and self-pay coverage).
4. Choose the Kind: Treatment for ongoing services (the default) or Assessment for evaluation codes. A new treatment authorization fills in an End date six months after the start (January 1 runs to June 30); change it when the payer approved other dates.
5. If it belongs to one course of treatment, choose the Episode of care. Leave No episode when it covers the whole discipline. Changing the discipline clears an episode from another discipline.
6. Choose the Status:
   • Requested when you have asked the payer and have no answer yet.
   • Pending when the payer is reviewing it.
   • Approved when the payer said yes. An approval needs the Authorization number the payer gave, unless it is provisional, and at least one approved quantity.
   • Denied when the payer said no.
7. Enter the Start date and End date. Both dates count as covered.
8. Under Approved quantities, enter the Visits, the Units or the Dollars when the payer approved them for the whole authorization. Leave them blank when the limits sit on the lines below.
9. Choose the Owner: the staff member who keeps the approval current. The owner gets the authorization alerts too, and the queue and the weekly review can show only their approvals.
10. Add the approved lines when the payer approved limits per code.
11. Click Add Authorization.

The authorization number prints on claims for the services it covers.

Provisional approvals#

Sometimes a payer approves care before the number arrives. Set the status to Approved and turn on Provisional; the number can wait. Appointments can be booked and delivered as usual, and the row shows a red Provisional badge. Their charges wait in charge review until you enter the number and turn Provisional off.

Start from a payer template#

If the payer has authorization templates, pick the coverage first, then click Use Template above the form and choose one. NeatPractice fills in the discipline, kind, quantities and lines, and sets the end date from the template's length. Check the numbers against the payer's letter, then fill in the rest.

Approved lines#

A line holds the limits the payer approved for one or more codes. Click Add Line under Approved lines for each one. With no lines, the authorization covers every code of the discipline.

• Codes: pick one or more codes from your clinic's procedure code list for the discipline (see Procedure codes). Codes on one line share its limits as one pool. A code may sit on one line only. If you change the discipline, codes the new discipline does not offer are removed and a message lists them.
• Units, Hours, Visits and Dollars: fill in the measures the payer limits and leave the rest blank. Hours take up to two decimals, for example 7.5. A visit is one date of service.
• Block past this: on, booking past that limit is refused; off, NeatPractice warns and lets the appointment through.
• Limits apply: Whole authorization, or a limit that renews every day, week, two weeks, month or quarter.
• Partial periods: for a renewing limit, a period cut short by the start or end date gets the Full limit, or a Prorated share by its days (a prorated month gets the weekly limit times the days in the month, divided by 7).
• Weekly cap (hours): the most hours to schedule in one payer week. For a whole-authorization line with hours, Use suggested fills in the total hours times 7, divided by the days in the authorization. Weeks start on the payer's work week day.

Two switches on each line reveal fields most payers do not need:

• Limits per appointment or day: the shortest and longest appointment in minutes, a Daily limit (once per day, or once per day per provider) and the most hours per day.
• Used before NeatPractice: the units, hours, visits or dollars already used under this approval before you started tracking it here. They count toward the limits.
• Hours the family accepts: when the family agrees to fewer hours than the payer approved, enter them with how often they renew (for example 10 hours per week). Booking past them shows a warning, and the utilization grid shows use against both.
• Provider or place required: Only this provider when the payer approved one provider for these codes, and the Place of service (two digits, for example 12 for home) when it approved one place. Booking anyone or anywhere else shows a warning that someone with the authorization override permission can book past.

Drag a line by its handle to change the order, or use the icons to copy or remove it.

Attach the approval letter#

If your role can view patient documents, upload the payer's letter on the Documents tab (see Documents), then pick it as the Approval letter. The list shows the chart's newest files that finished uploading; type part of the file name or description to find an older one.

Payer terms#

Under Payer terms:

• Approved providers: the providers the payer named. Booking another primary provider shows a warning.
• Allow blackout dates: visits under this approval may be booked on the payer's blackout dates.
• Claim contacts and fields: the managing and supervising providers, the referring and ordering providers, the EPSDT referral and the contract type the payer tied to this approval. On this approval's claims they replace the visit's supervising, referring and ordering providers and the coverage's EPSDT referral.

Verify with the payer#

When you confirm an approval with the payer, by phone or on its portal, open the row's menu and click Mark Verified. Enter the call reference or portal confirmation number, then click Mark Verified. The Owner column shows a green Verified badge; point at it to see when, by whom and the reference.

Verifying again moves the date forward. To take the mark off, for example when the payer changed something, click Clear Verification. Every mark stays in the chart's change history.

Dollar caps#

Some payers cap an approval in dollars instead of visits or units. Enter the Dollars under Approved quantities. Signed visits count their charges against the cap; booked appointments do not, since they have no charge yet. The Units column shows the dollars used of the cap, and the approval reads Used up once its charges reach it. A line can carry its own dollar limit too (see Approved lines).

What is left#

Each row shows the visits and units left, for example 12 of 20 left, 2 scheduled, and each line's codes with what was used of each limit, for example Hours 3.5 of 100:

• Used counts services that have been delivered against the authorization: each completed appointment is one used visit. Appointments do not count units.
• Scheduled counts booked appointments that will use it. Each appointment draws on the authorization that covers its date when it is booked; cancelled, rescheduled, late-cancelled and no-show appointments never count.
• Left is what the payer approved minus what was used.

NeatPractice works these numbers out again every time you open the tab, from the visits and appointments themselves, so you never update them by hand. Correcting the quantities or dates on an authorization changes what is left right away.

Utilization and weekly review#

Open a row's menu and click Utilization to see how the authorization is being used.

The Utilization tab lists each line with what is Authorized, Worked, Scheduled and Remaining, the Utilization (worked and scheduled, as a percentage of authorized), the hours or units Needed per week to use the rest by the end, and a Pace badge: On track, Behind, Over or Not measured. Choose:

• View: All time for the whole authorization (work done before NeatPractice included), or Month with the arrows to move between months.
• Measure: hours, units, visits or dollars.

When a line has hours the family accepts, the hours view adds Accepted and Accepted use columns.

Click Export CSV to download the grid as shown.

The Weekly review tab shows each line's payer weeks: the cap, the hours scheduled and worked, and the difference. A week that went over its cap shows the difference in red.

The status follows the numbers too. An approval whose end date has passed shows Expired, and one with no visits or units left shows Used up, without anyone editing it.

Alerts#

An approval shows a badge when it needs attention:

Once a day, NeatPractice also sends an in-app notification about each new alert to the providers on the patient's care team and to your front desk staff. The notification names no patient; it links to the chart's Authorizations tab. Each alert is sent once, and again only if you extend the end date or change the approved quantities.

Change the thresholds in Patient settings.

Request a renewal#

When care will continue past an approval, open the row's menu and click Request renewal. NeatPractice opens a new authorization with the same coverage, discipline, episode, kind, lines and quantities (but not what was used before NeatPractice), starting the day after the current one ends, with the status Requested. Enter the end date you are asking for and click Save Request.

You can also enter the new approval directly. An authorization of the same discipline and codes that starts the day after another one ends is linked as its renewal on its own.

When the payer answers, edit the request: change the status to Approved (with the number and the approved quantities) or Denied. A row with a renewal on file says Renewal requested and leaves the queue below.

Send a request to the payer#

If your clearinghouse takes prior authorization requests electronically, an authorization that is Requested or Pending has Send to Payer in its row menu. (Sending to the payer needs the Electronic claims add-on.) NeatPractice sends the dates, visits, procedure codes and units, and the episode's diagnoses. The payer's answer updates the authorization:

• Approved fills in the certification number and the dates and quantities the payer approved.
• Pended for review moves it to Pending; send it again later or edit it when the payer decides.
• Denied marks it Denied.
• Request not accepted changes nothing: fix what the payer named and send it again.

The status column shows the payer's last answer and when it came.

Overlapping authorizations#

Authorizations for the same patient may overlap. When a service could draw on more than one, NeatPractice uses the most specific one first: one with a line for the service's procedure code before one that covers the whole discipline, and one on the service's episode before one on no episode. Among equally specific ones, the one that ends first is used first.

Secondary payer approvals#

An authorization belongs to the coverage it was approved under. A secondary or tertiary payer usually approves the same hours again, so only primary approvals count toward a patient's authorized hours and the authorization revenue report. Such a row shows Not counted in hours. To add every payer's approvals together, turn on Count every payer's authorized hours in Patient settings.

Edit or delete#

To change an authorization, open the row's menu and click Edit. When the patient changes insurance, use Change insurance on the coverage instead (see Change insurance). Every change is kept in the chart's change history.

Delete is offered only while nothing has been scheduled or billed against the authorization, for one entered by mistake. A coverage or episode with authorizations on it cannot be deleted; end the coverage or discharge the episode instead.

The authorization queue#

Open Authorization queue in the Patients panel of the main menu to see the authorizations that need work across every patient you can see:

• Expiring: approvals ending within your clinic's number of days, or that ended in the last 30 days, with no renewal requested yet.
• Running out: current approvals that are used up or at the few visits or few units threshold, with no renewal requested yet.
• Requests: requests and pending authorizations waiting on the payer, oldest request first.

Click Filter to narrow a list by payer, discipline or Owner (pick yourself to see only your approvals), or pick patients in the patient panel. The Owner column also shows whether each approval is verified. Click a column header to sort by any column, and click a patient's name to open their Authorizations tab.

Weekly review export#

Click Weekly Review at the top of the queue to download this week's review as a spreadsheet. It lists every approval in force today, one row per line, with the payer week it falls in:

• what the week allows (the line's weekly cap in hours, or its share of the limit), what was worked and what is booked, and what is left this week and in total;
• the owner, the date it was last verified, its end date and days left;
• Needs a look, naming why: Over the week, Used up, Ending soon (14 days or fewer), Not verified or No owner.

For another week, an owner or only the rows that need a look, run the Authorization weekly review report under Reports and choose the Week of, Owner and Show options there.