In NikoHealth, authorization management is all about making sure the right prior authorizations are in place—and correctly recorded—so that Invoices don’t get held up or denied. Prior authorizations can be added to a Patient's profile. Below, we'll show you how to add a prior authorization to a Patient profile in Nikohealth. If you need more information on best practices for managing prior authorizations, visit our help article on this topic.
Navigate to the Patient Profile. Select the patient you're adding a prior authorization to and open that Patient's Profile. While in the Profile, click the NikoHealth blue action button and choose "New Authorization".
The "New Authorization" window will pop up, where you can add key details including auth number, type, any modifiers, the Payer associated with the auth, and more.
Complete the following information for this prior authorization.
Authorization Number
If you have already obtained an authorization number, you can enter it directly into the Authorization Number field. If the auth number is not yet available, you can use a placeholder such as "Pending" to indicate that the authorization is still in progress.
Authorization Type
Indicate if the authorization is for a purchase or rental.
HCPCS or Product
Choose between HCPCS or Product-specific for the authorization. If the authorization is for a HCPCS code, this will apply to all products associated with that HCPCS code. If the authorization is for a specific product, it will apply only to that product.
Modifiers
If applicable, you can add any relevant modifiers to the authorization. This is not a mandatory field.
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. For more information on adding Payers to NikoHealth, visit our help article on Adding Payers.
Set Effective Dates
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". Use the To field to specify the expiration date of the authorization, if applicable.
Units
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. This field is optional.
Dollar Amount
Enter a dollar amount for reference. This field is optional.
Notes
You can add internal notes to the authorization to include any important information relevant for this authorization.
When you've filled out all required fields, click "Create". This authorization will now be linked to the Patient record and visible for reference.
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.