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PreAuthorizations 

Preauthorizations are created and managed from the Treatment Plan module.  A preauthorization is very similar to an insurance claim, except that when it is sent, the date of service is left blank. The insurance company reviews the procedures sent and decides whether they are covered under the patient's contract. They will send back a form with an estimate of how much will be covered for each procedure.

Create a New Preauthorization

  1. In the Chart module, treatment plan the procedures. 
  2. In the Treatment Plan module, highlight one or more procedures by pressing Ctrl while clicking. 
  3. In the toolbar, click PreAuthorization.

All plans the patient is currently subscribed to will list. To list all insurance plans for the family, including inactive or dropped plans, check 'Show plans for family which are not in use by the current patient'.

  1. Select the Insurance Plan, the relationship to Subscriber, then click OK.
  2. On the Edit Claim window, click OK.
  3. Print or send the preauthorization electronically from the Claim Send window.

Manage Preauthorizations
Preauthorizations for a patient are listed in the top right of the Treatment Plan module. When you click on a preauthorization, all procedures attached to that preauthorization will highlight for easy viewing.  Double click to view or edit on the Edit Claim window.

Other Coverage:  Set other coverage (e.g. secondary coverage) after you create the preauthorization. Open the preauthorization, then at the top of the Claim Edit window, click Change next to Other Coverage.  This option can also be used to set primary coverage if this is a preauthorization to a secondary insurance plan.

'Receive' a preauthorization (when it comes back from the insurance company):

  1. Double click on the preauthorization.
  2. Click By Procedure in the upper right.



  1. Click in the Estimate cell to enter the estimate given on the EOB.
  2. For reference, enter the preauthorization number sent by the insurance company and any remarks. When you create the final claim on the Edit Claim window, you will need to enter the number from the preauth note in the Predeterm Benefits field.

The estimates will flow into the patient's treatment plan estimates.

Check Preauthorization Status: Check the status in the upper right of the Treatment Plan module, or use the Outstanding Insurance Claims Report and 'include preauths'.

 

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