Changing pre-authorization details

You can view procedures, change billing and rendering provider information, change claim information, and update the status for a pre-authorization.

To change pre-authorization details

1. On the Tx Planner tab of a patient's clinical record, do one of the following:

   • Create a pre-authorization.

   • Click (or tap) Pre-Authorizations to view a list of existing pre-authorizations. Then, click (or tap) the pre-authorization that you want to edit.

     

   The Pre-authorization Detail dialog box appears.

   New or Unsent Pre-authorization

   

   Sent, Queued, or Printed Pre-authorization

   

2. Change the details as needed on any of the following tabs:

   • Procedures

     The Procedures tab displays the associated procedures and conditions.

     

     Modify the procedures on the pre-authorization as needed:

     • To add procedures procedures to the pre-authorization, click (or tap) Add Procedure. The Add Procedures dialog box appears and lists procedures that are assigned to the same visit as the procedures already on the pre-authorization. Select the check boxes of the procedures that you want to add, or select the check box in the column header to select all procedures. Then, click (or tap) Add Selected.

       

     • To remove procedures from the pre-authorization, select the check boxes of the procedures that you want to remove, or select the check box in the column header to select all procedures. Then, click (or tap) Remove Selected. If you attempt to remove all procedures from the pre-authorization, a message appears and asks if you want to delete the pre-authorization. Click (or tap) Delete to confirm the deletion.

       

     For the procedures on the pre-authorization, the associated diagnoses appear. You can have up to four ICD-10 codes per pre-authorization. Modify the diagnoses as needed:

     • To remove ICD-10 codes, click (or tap) the corresponding Remove buttons .

       

       Note: Removing ICD-10 codes from a pre-authorization does not affect the corresponding procedures. All diagnoses remain attached to their corresponding procedures as currently posted in the patient's treatment plan and progress notes.

     • If you have less than four ICD-10 codes, to add an ICD-10 to the pre-authorization, select a diagnosis from the Select a diagnosed condition list. Only the diagnoses attached to the pre-authorization's procedures (as currently posted in the patient's treatment plan and progress notes) are available for selection. If there are two, three, or four ICD-10 codes, select the one that you want to be the primary diagnosis.

       

   • General

     The General tab displays billing and rendering provider information, the pay-to address, patient information, subscriber information, and payer information.

     

     Change the Billing Provider and/or Rendering Provider as needed. Only providers who have access to the location where the pre-authorization was created are available.

     Note: If the patient's insurance plan details have changed since the pre-authorization was created, a yellow warning symbol appears on the General tab, and next to Payer. Click the Refresh button to update the payer information.

     

   • Pre-Auth Info

     The Pre-Auth Info tab displays the name of the Referring Provider, the pre-authorization Reference Number, Orthodontia information (months remaining; and total months, the default value of which is calculated automatically, based on the placement date and remaining months specified, if the pre-authorization was created for orthodontic treatment), the Place of Service for the associated treatment, Accident Information (type, date, and state), and Remarks For Unusual Services (notes for the insurance carrier for this pre-authorization only).

     

     Enter or change any of this information as needed.

     Note: Only the first 80 characters of Remarks for Unusual Services are submitted electronically even though the box allows up to 151 characters.

   • Attachments

     The Attachments tab, displays the patient's perio exam and the images from the patient's Document Manager that are attached.

     

     Add and remove attachments as needed:

     • To attach an image from the document manager, click (or tap) Add From Document Manager. In the Add From Document Manager dialog box, select the check boxes of the images that you want to attach, and select a classification/type for each selected image (if necessary, you can change the classification/type later by selecting a different option from the Classification/Type list on the Attachments tab). Click (or tap) Done.

       

     • To attach a perio exam, click (or tap) Add Perio Exam to view a menu that lists the dates of the patient's perio exams, and then click (or tap) the date of the perio exam that you want to attach.

     • To remove attachments, select the All check box to select all the attachments, or select the check boxes of the attachments that you want to remove. Click (or tap) Remove Selected. On the confirmation message that appears, click (or tap) OK. The image is removed from the pre-authorization but not from the document manager.

     Notes:

     • The Add From Document Manager button is available only if the payer is a supported carrier (a carrier that was added to your practice database from the list of supported carriers that Henry Schein maintains). The payer ID of an unsupported carrier is 06126.

     • The Add Perio Exam button is available only if the patient has perio exams entered in his or her record and if the payer is a supported carrier (a carrier that was added to your practice database from the list of supported carriers that Henry Schein maintains). The payer ID of an unsupported carrier is 06126.

     • Only .jpg/.jpeg files from a patient's document manager are valid for images that you want to attach to pre-authorizations. You can attach only one perio exam to any given pre-authorization. You can have up to a total of 10 attachments per pre-authorization.

   • Status/Notes

     The Status/Notes tab, displays the status of the pre-authorization, the created and sent (if applicable) dates of the pre-authorization, and status notes. Some notes are entered automatically, such as a status message with an NEA number if the pre-authorization has attachments.

     

     To add a custom status update, click (or tap) Add Note, enter a message in the Note box, and then click (or tap) the Completed button .

     

3. Do one of the following:

   • To save and close the dialog box, click (or tap) Save and then Cancel.

   • To save the changes and submit the pre-authorization, click (or tap) Submit.

   • To save the changes and resubmit the pre-authorization, click (or tap) Resubmit.

   • To create a .pdf file of the pre-authorization, which you can print, click (or tap) Print and then OK on the message that appears. Use this option only if there are no electronic attachments for the pre-authorization.