Payer Reduced Authorizations

Payers can reduce the number of Authorized Hours (Units) for a previously issued Authorization. Providers who have already billed on the initial Authorization can bill up to the original listed hours, even when the invoiced amount is greater than what the updated Authorization allows.

For example, a Payer initially issues an Authorization for 120 hours and the Provider bills for 60 of those hours. The Payer then edits the Authorization, reducing it to 50 hours. In this case, the Provider has already billed, allowing the claim to go through; however, this Authorization can no longer be used. The balance of 10 units (hours) are displayed as negative in unit allocations.

Once confirmed, the Authorization is saved. Scheduled and Confirmed visits that were previously authorized become unauthorized due to the reduced units and turns pink on the Patient Calendar. Visits that are billed remain authorized; however, Units that are beyond the allowable amount in the updated Authorization are displayed as negative unit allocations. The following image illustrates a Weekly Authorization reduced from 20 to 15 Authorized Units per week.

Upon editing the Authorization, the system automatically issues a Patient Note and a Provider Email Alert (if configured) with the applied updates in a newly added grid, as seen in the image to the right.