How to Add a Prior Authorization to a Patient Record in NikoHealth
In NikoHealth, adding a prior authorization to a patient record is a straightforward process. You can create a new authorization or log a pending authorization, and you can specify various details such as the authorization number, product details, payer information, and timeframes. Here's a step-by-step guide on how to add a prior authorization to a patient's record:
1. Access the Patient Record
Search for the Patient: Navigate to the patient’s record where you want to add the prior authorization.
Open the Patient Record: Click on the patient’s name to open their record.
2. Add a New Authorization
Click the Blue "+" Icon: Inside the patient record, locate the blue "+" icon (in the top right side).
Select "New Authorization": From the action menu that appears, select "New Authorization" to begin the process of adding a new prior authorization.
3. Enter Authorization Information
This is where you’ll enter the details of the prior authorization.
Authorization Number:
If you have already obtained an authorization number, you can enter it directly into the Authorization Number field.
If the authorization number is not yet available, you can use a placeholder such as "Pending" to indicate that the authorization is still in progress.
Authorization Type:
Purchase or Rental: Indicate if the authorization is for a purchase or rental
Authorization Type (HCPCS or Product):
You can choose whether the authorization applies to a specific HCPCS code or a Product:
HCPCS Authorization: If the authorization is for a HCPCS code, this will apply to all products associated with that HCPCS code.
Product-Specific Authorization: If the authorization is for a specific product, it will apply only to that product.
Modifiers (if applicable): If applicable, you can add any relevant modifiers to the authorization.
Payer: Select the payer from the dropdown list. This list will display only the payers available in the patient’s record, ensuring that the authorization is correctly assigned to the appropriate payer.
4. Set Effective Dates
From Date: The From field is used to specify the start date of the authorization. If you leave this field blank, the authorization will be automatically marked as pending.
To Date: Use the To field to specify the expiration date of the authorization, if applicable.
5. Enter Units and Dollar Amount (Optional)
Units Authorized: You can enter the number of units for which the authorization is approved (e.g., number of items to be dispensed).
If more units are added to an order than what has been authorized, the system will notify the user that additional authorization is required.
Dollar Amount: You can also enter a dollar amount for reference.
6. Add Internal Notes (Optional)
Internal Notes: You can add internal notes to the authorization. This could include any important information relevant for this authorization.
7. Save the Authorization
Save: Once you have entered all the necessary details, click Save to log the authorization to the patient’s record.
The authorization is now linked to the patient’s record, and it will be visible for reference.
8. Automatic Posting to Claims (If Payer Rules Are Enabled)
If payer authorization rules are enabled, the authorization will automatically be posted to claims created for this patient, provided the claim includes services that are covered by the authorization.
This ensures that when a claim is generated, the system can check for active prior authorizations and attach the relevant one, streamlining the claim submission process.
Key Features and Benefits:
Placeholder for Pending Authorization: You can log and track authorizations even before a final number is obtained, keeping the process moving forward.
Service-Specific: You can specify whether the authorization applies to a HCPCS code (which applies to all related products) or a specific product.
Date Tracking: Set effective start and end dates for the authorization to track expiring authorizations.
Automatic Unit Checking: The system notifies users if the number of units requested exceeds the authorization, reducing the chance of claim denials.
Seamless Claims Posting: With payer rules enabled, the authorization is automatically linked to any claims, ensuring claims are processed in line with payer requirements.
Internal Documentation: Add notes or internal references to track the details of the authorization for future reference.
By following these steps, you can ensure that prior authorizations are properly logged in the patient's record and are automatically applied to claims when appropriate. This process helps streamline workflows, reduces the chance of billing errors, and ensures that services are covered under the patient’s insurance plan.