Steps to Track Authorizations in NikoHealth
1. Navigate to the Billing Section
Go to the Billing Section: On the main dashboard or navigation menu, find and click on the Billing section.
Click on the Authorizations Page: Within the Billing section, locate and click on the Authorizations page. This will allow you to view and track all authorizations logged in the system.
2. Review Authorization Status
Once you're on the Authorizations page, you will have access to a list of all prior authorizations logged for patients. The authorizations are categorized into four main statuses:
New Authorizations:
Definition: These are authorizations that have been logged with a future effective date. This means the authorization is not yet active but will become effective at a later date.
Use Case: This is useful for when authorizations are obtained for a future effective date. For example, an authorization for a product or service may be logged as "new" but will only become active once the effective date is reached.
Action: You can review these authorizations to prepare and ensure they will be active when needed.
Active Authorizations:
Definition: These are authorizations that are currently active during the specified period. An active authorization means that the service or product is authorized and will be covered by the payer as long as it falls within the authorization timeframe.
Use Case: Active authorizations are critical when preparing claims or providing services. For example, if a product or service is within the authorization period, you know it is covered.
Action: You can use the active authorization details to ensure that claims are submitted correctly. If you’re adding services or products to the order, the system will validate that the authorization is active.
Expired Authorizations:
Definition: These are authorizations that have expired, meaning the period of coverage has ended. Services or products supplied after the expiration date may not be covered unless a new authorization is obtained.
Use Case: Expired authorizations indicate that the patient may need a new authorization to continue receiving services or products. This status serves as a reminder to request a renewal or a new authorization.
Action: If an authorization has expired, you will need to request a new authorization from the payer to ensure future claims are covered.
Pending Authorizations:
Definition: Pending authorizations are those where an active authorization with an effective "From" date has not yet been obtained. These authorizations have been requested but have not yet been approved or issued.
Use Case: Pending authorizations indicate that the process is in progress, but coverage is not yet confirmed. For example, a request has been submitted to the payer, but the authorization number or approval is still pending.
Action: Pending authorizations require follow-up with the payer to confirm whether the authorization is approved. You may need to contact the payer or monitor the status until it is confirmed.
3. Filter and Search Authorizations
Search Options: To make it easier to find specific authorizations, NikoHealth typically provides search and filter options, allowing you to:
Search by Patient: Look up authorizations for a specific patient.
Filter by Status: View only New, Active, Expired, or Pending authorizations.
Filter by Date: Filter by authorization effective dates or expiration dates.
Sorting: You can also sort the list of authorizations by different criteria, such as the authorization number, payer, or effective date, to quickly find what you’re looking for.
4. Take Action on Authorizations
Depending on the status of the authorization, you can take different actions:
For New Authorizations: If a future authorization is logged, ensure that the service or product is scheduled for when the authorization becomes active. You can prepare for the service by checking the effective date and tracking its progress.
For Active Authorizations: Ensure that the authorization details (such as the number of units or specific product codes) match the services being provided. When creating claims, the system will automatically pull in these active authorizations, so make sure the details are correct.
For Expired Authorizations: If an authorization has expired, you will need to request a new authorization from the payer before proceeding with additional services or submitting claims. You can track the expired authorization and use it as a reference when initiating a renewal request.
For Pending Authorizations: If an authorization is pending, you will need to follow up with the payer to determine if the authorization has been approved or issued. You may also want to check the status periodically to keep track of when it becomes active or if additional documentation is required.
Key Benefits of Tracking Authorizations in NikoHealth
Real-Time Visibility: Tracking authorizations in real time allows you to stay on top of approvals, ensuring services are covered and claims are processed without delays.
Proactive Monitoring: By reviewing new, active, expired, and pending authorizations, you can take proactive steps to ensure coverage is in place and avoid claim denials due to lack of authorization.
Efficient Claim Management: Automatic linking of active authorizations to claims ensures that claims are processed smoothly, with no manual intervention needed to confirm authorization status.