Having the ability to determine when an appointment, procedure or medication requires an authorization is vital to a health care organization’s success. HEI’s Pre-Authorization solution has the flexibility to develop rules to flag when a pre-authorization would be required.
Pre-Authorization
Pre-Authorization Flagging
Pre-Authorizations can be flagged at the visit, scheduled appointment or individual procedure level and can be based off your individual payer contracts. These authorizations can be worked manually or electronically based on individual insurance payer abilities. Authorization details such as authorization status, authorization number, authorization reason, days authorized, authorization expired date can be stored on each item that has been flagged.
Check for Pending Authorizations
While working in the Pre-Authorization Module the user has the ability to check to see if any other items may require an authorization.
Add on Pre-Authorizations
In addition to appointments, procedures or medications that have already been flagged for a pre-authorization the user has the ability to manually add a pre-authorization on any order or appointment that is associated to the patient’s current visit.
Registration and Clinical Pre-Authorization Integration
Pre-authorizations can be viewed and maintained out of registration as well as the patients clinical record. This allows the clinical staff to ensure authorization are approved prior to preforming the service.
Scheduling and registration staff can alert a patient about an unauthorized order or appointment at check-in or prior to arrival.
Unauthorized Work Queue’s
When pre-authorizations are pending, denied or require additional information prior to approval these items are identified and can be worked out of an unauthorized work queue.
