SmartCare provides users with the ability to create a billing rule requiring an authorization to be attached to certain procedures. Please see steps below:
- Click the Search icon.
- Type Plans into the search bar.
- Click to select Plans (administration).
- Click the Plan Name hyperlink that requires the authorization.
- Click the Rules tab.
- In the Rule Generation section, click the drop-down arrow and select Authorization is required. The Rule Name will auto populate.
- Click the Code(s)… button.
- In the Available Codes pop-up, click the checkbox(es) for the procedures that require authorization.
- Click Save.
- Click Close.
- Click the Insert button.
- Click Save.
Note: When a service is entered for a client and an authorization record does not exist for the service, a service error will appear preventing the service from moving to a Complete status until an authorization has been entered and linked to the service. This check is done against all plans that the client has coverage for.
For example, if the client has Medicare as primary and Medi-Cal as the secondary payer and Medi-Cal requires the authorization for the procedure then the service error will appear and indicate that for Medi-Cal authorization is required.
