Objective
This guide outlines the steps for handling authorizations, from marking an appointment as pending auth, to adding authorization details, and ensuring claim data is processed correctly.
Key Steps
1. Identify When an Authorization is Needed
Open the Appointments page.
Select a patient’s appointment.
Check the authorization section:
If it says “No Authorizations Found”, the appointment may require one.
Only certain appointments will have authorizations (e.g., Filter: Pending Auth, Submitted Auth).
The same check can be done from the Orders page.
Authorization can be added regardless of the appointment status.
Note: Authorizations allow our team to link an authorization number directly to both the appointment and the order, ensuring accurate claim data and smoother billing downstream.
2. Add an Authorization
From the appointment or order, click Add Authorization.
Enter the following details:
Reference number from the payer (Add as Additional Notes under the Notes section).
Authorization Status
Coverage dates (required).
Payer (insurance company).
Procedure codes (these auto-populate from the order/appointment).
Click Create Authorization.
The record will now display under the appointment/order, instead of “Add Authorization.”
3. Update Authorization Status
After submitting to the payer, update the status:
Pending Auth → Patient flagged as needing an authorization.
Submitted Auth → Request has been filed with the payer.
Approved → Payer has confirmed approval.
Status changes ensure billing and claims teams know the current stage.
Note: Copy and note the Authorization Details
4. Attach Authorization to Orders
Authorizations are automatically linked to both the appointment and the order once created.
When an order is marked as delivered, the authorization is stored with it.
If an order requires an authorization that has not been approved, it will remain in Pending until updated.
5. Generate Claim Information with Authorization
Go to the patient’s order.
Click Create 1500 Form.
If the authorization is still Pending, the system will block claim generation and prompt you to wait.
Once marked Approved, the authorization number will appear in the correct field on the 1500 claim form.
Click View to preview the 1500 Form.
Click on Generate Claim Lines to view the claims spreadsheet.
When exporting claims to a spreadsheet, the authorization number appears in the new Authorization Number column.
Error Messages
If Authorization is not approved and the user attempts to generate a claim or print a CMS-1500 form, the portal will display the following message at the bottom right corner.
Failed to create 1500 Form
Failed to generate 1500 Form.
Authorizations exist for order [Order Number] but no specific authorization found. Please export the claims without order [Order Number] and try again.
This prevents billing without a valid authorization.
Users must return to the Authorization tab to complete or correct the missing approval before updating the status to Approved.
Once the status has been updated, go to Documentation.
Trigger the Create 1500 Form button to generate the form with the details
Once the 1500 Form is created, you can now view the form by triggering the View icon.
Important Notes
Adding an authorization in the portal does not generate the auth. Staff must still call payers and file paperwork.
Always include the reference number and coverage dates.
Authorizations attach to both appointments and orders once created.
Claims without an approved authorization cannot be billed.
Tips for Efficiency
Always update the status (Pending, Submitted, Approved) so billing knows the current stage.
Enter notes in the auth record if extra details are required.
Double-check that coverage dates match the appointment/order dates.