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.
Alternantive Workflow
Follow steps 1-5 above.
- In the Rule Generation section, click the drop-down arrow and select These Programs require authorization for these codes. The Rule Name will auto populate
- Click the Program(s)… button:
- In the Available Codes pop-up, click the checkbox(es) for the procedures and programs that require authorization and click Insert to add to the table.
- Click Insert.
- Click Save and Close.
An action can be chosen to determine what should occur if the rule is broken.
- This rule allows a Start and End date to be configured which will then apply the rule only to dates of service that fall between the dates entered.
- Click Insert.
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.
