Prior Authorization Overview

TherapyNotes makes it easy to view, add, and edit prior authorizations and track their usage and expiration dates. In addition, prior authorizations can easily be disabled, and prior authorization reports can be filtered by multiple parameters.

View, Add, and Edit Prior Authorizations

  • Prior authorizations are displayed within an insurance policy.
  • You can enter both Start and Expiration dates for prior authorizations.
  • Usage Setting radio buttons allow you to specify whether the authorization is Once per Service or Per Unit.
  • Service codes can be set to "any", include add-on codes, or specific service codes can be set.
    • The options will only display unique service and add-on codes.
    • Multiple authorization codes for a single service code for the same time frame may be added.
    • A warning displays when a service code not listed in practice settings exists as a value or is manually entered.

  • When editing a prior authorization, warning messages appear if the prior authorization is expired, has no uses remaining, has been used on a claim, if one or more service codes do not exist, or if incorrect values are entered for the number of uses allowed or uses remaining.

  • The number of Uses remaining is deducted after prior authorizations are submitted.
  • If multiple codes are submitted with applicable prior authorizations, the number of uses remaining is deducted for each applicable service code.
  • Warnings will display next to the Code column of the Prior Authorizations table to alert you of prior authorizations that have less than 2 uses remaining, are expiring soon, are expired, or have deleted service codes.

  • When viewing a claim on the Submit Electronic Claims page, a yellow banner will display showing how many uses are left if the prior authorization for the claim has fewer units remaining than are needed for submission.

Learn more about adding and editing prior authorizations.

Disabling and Deleting Prior Authorizations

  • You can delete a prior authorization if it has been saved and has not been used on a claim. If it has been used on a claim, you can only disable it.
  • If you re-enable a policy, the prior authorization will not automatically be enabled; you will have to manually re-enable it.
  • An X will appear in the upper right of the prior authorization box if the authorization can be deleted. A warning dialog will display when you try to delete a prior authorization.

  • If you disable a policy, the prior authorization will automatically be disabled. You can view a disabled policy with prior authorization by toggling Show Disabled Policies on the insurance editing screen. Disabled policies will display below Enabled policies.

  • You can view disabled prior authorizations within an insurance policy by toggling Show Disabled Authorizations in the prior authorizations section of the insurance editing screen. Disabled authorizations will display below Enabled authorizations.

Prior Authorization Reports

  • Prior Authorization reports can be filtered by Expiration Date, Status, and Uses Remaining.
  • Reports display warning messages if the prior authorization is expired, if there are no uses remaining, or if one or more service codes do not exist.
  • All columns on the report are exported when downloading as an Excel spreadsheet.

Learn more about creating a prior authorization report.

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