Authorizations: How to Add/Edit

AgileEMR: Authorizations

FEATURE PURPOSE: To allow users to add or edit authorizations within Agile to match the patient's current insurance coverage and track it within the system.

1. Adding an Authorization:

• Enter patient's case
• Click on the Insurance Tab
• To begin entering the Authorization information, you will first want to click on the "Not Applicable" check box. The system will default to "Not Applicable" checked, but you will not be able to enter the required information until this has been unchecked. 

• Once this box has been unchecked, you will have the option to select the Rule associated with the Authorization by clicking the drop-down. The drop down will provide the below options:
  • Custom Rule: This rule functions the same as the current system, but it is for visual reference only and will not alert for authorizations. 
  • Before Evaluation/Re-Evaluation: Authorization is needed before the evaluation and for subsequent visits.
  • After evaluation, but before next visit: Authorization is not needed for the evaluation, but is needed for the visits following the evaluation.
  • Separate auths for evaluation and treatment: When the insurance requires a different authorization code for the evaluation AND treatment separately. 

• Next you will manually enter the authorization information - the following are fields that must be completed before the program will allow you to save.
  • Mandatory Fields:
    • Authorized Visits
    • Authorization Number
    • Call Reference Number
    • Authorization Start 
    • Insurance Representative - Insurance Representative that you received the authorization from. If you receive this information online, you can just simply enter "Online" in this field.

• The Authorization End is the only field that is not mandatory and can be left blank when saving the authorization information for the first time. Another thing to keep in mind is that the authorization start date must match, or fall within the insurance date range, or it will not accept it. 

• When all Authorization information has been entered and has been verified, hit the "Create Coverage" button, or if adding it to an insurance that has already been created hit the Update Coverage button. 
• If you do not choose either of these options after manually entering in insurance information, the system will not save the information you have just entered and you will need to re-enter that information. The system will not automatically save this information for you. 

2. Editing an Authorization:

To edit an authorization that has NOT been billed to insurance:

• Select the Edit button.

• ALL fields will be editable for you to make the necessary changes. Make changes and press Save.

• Once you have saved your changes, be sure to click on "Update Coverage" or the changes will not be saved to the insurance plan. 

3. Deleting an Authorization:

• To delete an authorization, press the Trash Icon next to it within the Authorization Information Table.
• The system will populate an alert to verify the deletion of authorization information. To confirm, press Delete.
• Once deletion has been confirmed, the authorization information will be removed.

4. Adding Multiple Authorizations:

• To add an additional authorization, press the Add button next to the Authorization Status Bar.

• Enter in the new authorization information into the necessary fields and press Save.

NOTE: Date ranges cannot overlap. If you receive a message for overlapping dates, adjust the end date of the previous authorization with the edit button (refer to pg 7) and try again.

Occasionally, you may run into an Insurance that has an authorization checked, but the insurance plan should NOT require an authorization. If this happens, please mark the Insurance as error and click Add Coverage. From there you can add the insurance back without the authorization and Update the Coverage. The system will not allow you to remove this authorization unless the insurance is entirely removed first. As always if you have any questions at all about an authorization in general, please reach out to support: (616)-588-8455 or support@agilerpm.com.