Overview

A limitation can be set on the Authorization for specific Procedure Codes, including an authorized Unit limit for each code.

• Multiple Procedure/Unit associates are useful when an Authorization includes different Unit limits for specific Procedures.

• This allows each approved Procedure to be tracked individually instead of sharing one total Unit balance across all services.

Key Concepts

Authorization: An Authorization is used to track payer-approved services and Unit limits for a Patient's care.

• Authorizations can be linked to a Case and applied when posting Charges.

Procedure Limitations: A Procedure limitation restricts an Authorization to specific Procedure Codes.

• When enabled, only authorized Procedures can be billed using that Authorization.

Unit Limits: Each Procedure can have its own authorized Unit limit.

• Once the limit is reached, additional Charges using that Procedure cannot be posted until the Authorization is updated/expired, or a different Procedure is used.

Multiple Procedure Associations: An Authorization can include multiple Procedure Codes with separate Unit limits.

• This is usefully when a Payer approves different quantities for different services under the same Authorization.

Add a Procedure to a New Case

1. On the Add/Modify Case screen, select the Add Authorization link, or enter [Ctrl + F7]

2. In the Procedure and Units fields, enter the Procedure Code associated with the Authorization and the number of authorized Units.
3. To add additional Procedure Codes, select the plus icon (+).

• Up to 10 Procedure Codes can be added.
• The Total Units field will update automatically based on the sum of all Procedure Unit values entered.

4. Select Save [F2].

Add a Procedure to an Existing Case

1. On the Modify Charge screen, select the Authorization dropdown.
2. Select Add New from the dropdown if no Authorization currently exists, or select Modify to edit the existing Authorization.

3. Add the Procedure Code(s) and Units.
4. Select Save [F2]

Validation Errors

Error - At Least one Authorized Procedure Must be on the Charge

This error indicates that the Authorization has a Procedure limitation in place.

• At least one authorized Procedure Code must be included on the Encounter.

Error: No Remaining Unites for the Procedure Code

This message indicates that the authorized Unit limit for the selected Procedure Code has been reached.

• To continue, either:

• Increase the Unit limit on the Authorization (if additional Units were authorized)
• Remote the Procedure Code from the Charge.