Overview
The Prior Authorization feature allows providers to create supporting documentation for insurance approvals. This ensures that all necessary clinical details, diagnoses, and notes are compiled into a formatted authorization document for submission.
Summary
Go to DME → Appointments and open the patient’s appointment.
Open the Details tab to review appointment information.
Check the Authorization section — if “No Authorizations Found,” create one.
Click Create Prior Authorization Documentation.
Fill out the form:
Select Procedure Type (Wound Procedure or CPAP Device).
Add Requested Codes (HCPCS/CPT) if needed.
Add Comorbidities (optional, multiple can be selected).
Add Additional Notes to support medical necessity.
Click Generate Authorization to create the document.
Review the generated document for:
Patient and appointment details
Diagnosis and procedure codes
Coverage criteria and medical necessity
Product codes, quantities, and frequency
Confirm accuracy before submitting to payers.
Step-by-Step Guide
Open the Patient’s Appointment
Navigate to DME section and go to Appointments
Select the specific appointment that requires a prior authorization document.
Access the Details Tab
Identify When an Authorization is Needed
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.
Create Prior Authorization Documentation
Select the Wound Procedure
Wound Procedure
CPAP Device
Add the Requested Codes. This is optional.
HCPCS
CPT
Search and add Comorbidities (optional)
Search and select any comorbidities related to the patient’s condition
You can select multiple comorbidities
Add Additional Notes (optional) if needed
Add any supporting details that may help justify medical necessity, such as history of failed treatments, duration of wound care, or other relevant observations.
Generate Authorization to create the Authorization for this appointment
Once generated, you’ll see the Create Prior Authorization Documentation button replaced by the documentation itself.
View the document to review the documentation.
The document covers:
Appointment Details (Patient Name, DOB, Provider, Procedure, Requested Codes (HCPCS), Care Setting (If home health option is decided))
Coverage Criteria (wound details)
Medical Necessity
Anticipated Wound Plan
Product and Codes
Quantity and Frequency
Contraindications
Documentation
Signature
Button Functions of Documents
Tips for Efficiency
Use accurate and complete diagnosis codes to prevent delays in approval.
Include comorbidities that directly impact medical necessity.
Save time by preparing common comorbidity lists for frequent cases.
Important Notes
Prior Authorization documentation is for clinical and insurance use only.
Ensure all data entered is verified against the patient’s record before submission.
Always review generated documents before sending to payers.