Prior Authorization - sub module

Create Prior Authorization Module

• Insurance Claim (Access point to Prior Authorization)

• Prior Authorization Request Screen

• Prior Authorization Status - create statuses for clients to assign

• Requires User to assign Patient's Personal Profile with MR#

  • Required Patient Demographic Information

• Order Information

  • Assign ordering providers

    • Schedule Order Entry of Test/CPT Code and Diagnosis Code

    • Internal Future Order: Requirement Diagnosis with CPT

  • Link to Scheduler

  • Link to TB RCM - Eligibility/Verification, Medical Necessity, PLE

• Insurance Coding Screen - Add Condition, Value, Occurrence Codes

• Create Modifier Screen - Modifier can linked to charge code

• Assign Insurance Payer Primary, Secondary, etc.

  • Insurance Info

  • Policy Information

  • Subscriber Info

  • Approval Date / Time

  • Denial Date /Time

    • Reasons

• Upload & Scan documents

• Option to send message via Web Client Communication Center

• Prior Authorization Notes - users can notate event

• Create an option where users are unable to over-ride authorization to process order

• Options:

  • Complete - Create a pre-admit account, option link to scheduler

  • Incomplete - stays in prior authorization queue

  • Delete -

  • Cancel

• Create PDF , CSV, TXT report