Overview
An authorization is the pre-determined permission to bill a specific service given by a specific payer. In PIMSY, we have taken that definition and expanded upon it. In order to write a note, you must have an authorization (auth) to use that code on that client; this can either be a real authorization from a payer source or a placeholder auth assigned by support/admin staff. Either way, permission to document on a code (service) must be assigned.
Required Permissions and Prerequisites
- Please assign the Create, Modify, View, and Delete permissions for the following rule(s):
- Auth Groups
-
Client Authorizations
- Can modify the remaining units, end date and unmanaged flag on managed auths
Step-by-Step Instructions
Step 1: Billing Code Setup
The Billing Code Setup setup instructs the system on how authorizations should to be decremented specific to each billing code. To access Billing Code Setup go to:
Financial > Billing Codes
The Auth Decrement Action field specifies how many units should be deducted per note or per time frame, depending on how the code is configured.
The Default Units column indicates the total number of units that are typically allowed for the code. If you'd like a particular code to be automatically applied to new clients upon creation, simply check the Add to New Clients box.
Step 2: Setting Up Billing Code Group Assignments
The Billing Code Group Assignments screen allows you to create billing code groups that represent code bundles or different authorization groups. These groups help organize and manage how billing codes are applied based on specific needs or payer requirements.
To view the billing codes assigned to a group, simply select a Billing Code Group from the dropdown menu. All associated billing codes will be displayed for easy review and management.
Step 3: Basic Auth Groups
An Auth Group allows the system to deduct authorization units from a shared group rather than from individual billing codes.
To assign an auth group to a client, open the client's chart and go to the Auths tab. Start by clicking on a new line, selecting a billing code from the dropdown, and entering effective dates the total number of authorized units. In the next column, enter the number of remaining units, which may be different if the client received services before the authorization was entered.
Once all applicable codes have been added, select the appropriate Auth Group from the dropdown menu in the corresponding column (based on the group name you created), then save your changes. Going forward, whenever any of the codes in that group are used, PIMSY will automatically deduct from the group total to help ensure billing stays within the authorized limit.
The system will tell you how many notes have been started with that specific authorization by displaying any units that are pending release by displaying the units in the Pending Units column. Upon releasing the note, the units will deduct from the Remaining Units field.
Step 4: Bulk Add or Update Authorizations
To add a group of codes or update authorization codes for a single client, go to the client’s chart and open the Auths tab. Then, click on the Bulk Add or Update button in the upper right corner of the screen. In the dialog box that appears, select the title of the Auth Bundle in the Billing Code Group dropdown, and fill out the fields in the Add New Codes to Clients listed section at the top of the page. This will allow you to efficiently assign or modify multiple authorizations at once.
The bottom section allows you to easily update the displayed codes on the client. You may use this if you need to adjust the expiration date of all the codes listed on the client, or change the remaining units, or add an authorization number to the claims for that service.
**Before using this feature, it's important to understand how to apply filters correctly to ensure you’re working with the intended codes.
When updating, enter only the specific information you wish to change. For example, if you’re updating the End Date on existing authorizations, leave all other fields blank so that only the end date is modified.
Once your changes are entered, click Update Codes Listed. A confirmation box will appear, notifying you that all codes currently displayed will be updated. Click Yes, then OK to confirm. You’ll see that all listed codes have now been updated with the new information you entered.
The Unit Alert Level field is used to trigger system alerts when a client’s remaining units reach a specified threshold. This alert is sent to users who have the appropriate profile rule set to receive authorization alerts.
For example, if a client is authorized for 12 visits and you want to be notified when only 2 visits remain, enter 2 in the Unit Alert Level box. The system will then send an alert once the client’s available units drop to that number.
Expiration Alert Days allows you to choose how many days in advance you’d like to be alerted before a client’s authorization period ends. The system will notify eligible users the specified number of days prior to expiration.
The Unmanaged option may be used for internal billing codes that are not associated with insurance as well as services that are not limited by insurance carriers.
Enter a Start Date and an End Date of the authorization. This date span is the only time the code will be available. The system will inactivate the codes based on these dates if setting 13 is set to True.
Once you’ve completed all the necessary fields in the top section of the Bulk Add or Update window, click the Add New Codes to Clients button, then select Close. The billing codes you added will now appear in each client’s chart under the Auths tab.
The Auth # Field should be populated with a valid authorization number if provided by the payer. Anything that does not begin with an "N/A" will go out on claims sent via an 837.
To Bulk Add or Update Authorizations for multiple clients at once, go to the next step.
Step 5: Global Authorizations Screen
The Global Authorizations screen provides a comprehensive view of every authorization in your system at a glance. This screen includes powerful filtering capabilities, allowing you to sort and manage authorizations based on a variety of criteria. To access, go to:
Clients > Authorizations
The Filter for Upcoming Inactivations serves as a live, ongoing report. After selecting this filter and refreshing the screen, the system will display clients whose remaining units are nearing depletion. This list can also be exported to Excel for further analysis or tracking.
From this screen, you can also Bulk Add or Update all authorizations currently displayed. However, it’s important to apply appropriate filters before taking action to ensure that updates are only applied to the intended records.
Additionally, you can Bulk Add or Update Authorizations for multiple clients at once here. Use the filters to narrow down the list to the specific clients you want manage. Once you’ve selected the appropriate clients from the filtered list, follow the same steps outlined above to add or update their authorizations in bulk. This feature streamlines the process of managing authorizations across multiple clients, saving time and ensuring consistency.