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How to Add an Authorization to a Client's Chart

Overview

This article walks you through how to enter authorizations on the client file in PIMSY so you can begin documenting services, scheduling appointments, and billing appropriately, all while ensuring you do not exceed any limitations set by the payer.

 

Required Permissions and Prerequisites 

  • This article is in reference to our Desktop application
  • Please assign the Create, Modify, View, and Delete permissions for the following rule(s):
    • Client Authorizations 
  • Recommendations:
    • We recommend reserving the rules Client Authorizations Delete and Client Authorizations Modify (can modify the Remaining Units, End Date and Unmanaged flag on managed auths) for management
    • Ensure that you have an empty row on the Client Authorization screen. If you have more than one empty row, you will not be allowed to save. 

 

 

Step-by-Step Instructions

 

 

Step 1: Go to the client's chart 

From the top navigation menu, go to:

 Clients > Client Management

 

 

Step 2: Click on the authorization tab 

In the top-right corner, click the + Add New button.

 

 

Step 3: Click in the dropdown on the empty row at the bottom

Enter the following required information in the new row:

  • Billing code given by the authorization/insurance company
  • Start date of the authorization
  • End date of the authorization
  • Allotted Units given on the authorization.
    • Please note, if the authorization is not specifically given units but rather time driven you can enter "1" and check the "Unmanaged" check box to the far right.
  • Enter the same value for Allotted units in the Remaining Units and this is what the system will deduct from.
  • If you want to be alerted when a managed authorization gets down to so many units, place that value in the "Unit Alert Level".
  • If you want to be alerted when a managed authorization expiration date is approaching, place that value in the "Exp. Alert Days".
    • For example, if you know your payer takes approximately two weeks to reauthorize a service, and they are seen weekly, you might put "2" for the Unit Alert Level, and 14 for the Exp. Alert Days. This will alert you when there are two remaining units, or 14 days before the authorizations End Date (whichever comes first). 

Optional:

  • Auth #. This field will go out on a claim form, so only add text if the payer requires you to bill with the authorization number. Disregard the "N/A" that the system stamps here. The 837 EDE files are specifically coded to omit this text from claims.
  • Specific Provider can be used when the payer gives units specifically to one provider. If this is not specifically listed, you should not list the Primary Therapist here.
  • Ins. Company can be assigned to any payer that is listed in the Client's Insurance History tab. This is extremely useful if you have a billing code that can bypass the normal hierarchy of billing the primary first, and automatically going to the Secondary, or if the client has specific services that are provided by one provider and should only be billed to Self Pay.
  • Do not check or uncheck the "Active" box. The system is designed to automatically edit that box based off settings 52 and 13. These settings will automatically expose the authorization to be utilized during the time frame listed in the start and end dates, but don't worry. If an authorization expired, as long as there are available units, PIMSY will allow providers to document with it if the date of service falls with the date range.
  • Please note, if setting 275 is set to True, it will not deduct units for clients with Self Pay listed as their primary payer. 

 

 

Step 4: Save the Record

Click Save at the top left corner of the Authorizations tab. PIMSY will automatically assign a unique Billing Client ID to this authorization. This is what will follow the services through the scheduling, documenting and billing. This ID is what the system will track in the audit. 

Note, the information pertaining to this authorization will show everywhere the authorization is listed, For example when opening a Service Activity Log (SAL) Appt, you will see the billing code in the dropdown, followed by the description of the code, the number of Units Remaining for the auth ("# ur"), and the authorization number. 

 

 

 

 

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