CalMHSA Connex: Prior Authorizations Overview

Overview

Prior Authorizations (PAs) in Connex manage the approval process for healthcare services that require pre-authorization before they can be delivered. The system supports creation, submission, review, and tracking of authorization requests across your organization.

The Prior Authorizations section is organized into two views:

  • Action Required: Shows authorizations that require your attention — such as those with an Approved, Denied or Information Requested status for your organization. Sorted by due date so the most urgent items appear first.
  • All Authorizations: A complete list of all authorization requests for your organization, regardless of status.

All Authorizations

To navigate to the Action Required screen, follow the steps below:

  1. Once you are logged into Connex, click the Authorizations drop-down from the lefthand navigation menu.
  1. Click All Authorizations and all authorizations, no matter the status, will display to the right.
  2. To view the authorization details, click the hyperlinked Purpose name.
  1. Once an authorization has been selected the detail page will appear, which is organized into several panels:
    1. Summary Panel: Displays the key details of the authorization including:
      • Service category and specific service type
      • Current status (with color-coded badge)
      • Urgency level
      • Service start date and due date
      • Frequency (how often) and duration (how long)
      • Justification: if provided
      • Diagnosis: if provided
      • Override values (shown when the reviewer has modified the original request values)
    2. Authorized Reviewer: The requested reviewer
    3. Service For: This is the Patient Panel and shows the patient’s demographics and relevant information pulled from the patient’s record.
    4. Requestor: The authorization requestor
    5. Attachments: Upload and manage supporting documents. Each attachment is tagged with a document type.
    6. Related Referral: If the authorization is associated with a referral, it will be displayed here with a link to the referral detail page. You can link or unlink referrals from this panel.
    7. Notes: A chronological list of notes added by all parties. You can add, edit, and delete notes. Notes support rich text formatting.
    8. History: A timeline showing every status change from creation to current state, including who performed each action and when.
 

Action Required

To navigate to the Action Required screen, follow the steps below:

  1. Once you are logged into Connex, click the Authorizations drop-down from the lefthand navigation menu.
  1. Click Action Required and the corresponding authorizations will display to the right.
  2. To select an authorization to act on, click the hyperlinked Purpose name to open the authorization.
  1. This will bring you to the Prior Authorization details page. Users with applicable “Prior Authorization Approver” permissions see a Pending Review queue showing authorization requests submitted to their organization. The review interface provides three primary actions:
Note: You must have approver access to do any of the steps below:
    1. Approve: Click the “Approve” button to approve the authorization. An approval dialogue box allows you to:
      • Add an approval note
      • Optionally modify the start date (override)
      • Optionally modify the duration (override)
      • Note: Override values are tracked separately from the original request values, so the original request is preserved for audit purposes.
    1. Reject: Click the Reject button to deny the authorization. You must provide a rejection reason in the dialog that appears. The rejection note is saved to the authorization record and visible to the requesting organization.
    2. Request Additional Details: If you need more information before deciding whether to approve or deny the request, click “Request Additional Details” and add any comments regarding the information to be included in the re-submission. This changes the authorization status to “Information Requested” and notifies the submitter that additional information is needed so that they can re-submit after making the requested changes.
    1. Additional Reviewer Actions:
      • Edit: Modify details of the authorization request
      • Withdraw: Withdraw the authorization
      • Reactivate: Reactivate a previously withdrawn authorization.