New Authorization

When clicking on the New Authorization link in the Authorization menu (this menu is described in Authorizations Menu), a New Authorization page is opened where the user can create a new Authorization by following a multi-step process guided by a wizard. At the end of the process, the wizard is closed and a View and Edit Authorization page (described in View and Edit Authorization) is opened in the context of the newly created Authorization. The data model related to this page is described in Data Model. The retrieval and display of data in this page is subject to restrictions described in the "User Access Restrictions Model" chapter of the Security Guide.

The wizard consists of the following steps (in specified order):

  1. Form

  2. Specifics

  3. Service types

  4. Lines

  5. Diagnoses

  6. View and save

Back and forth navigation is possible by using the Back and Next buttons within the steps or by clicking on the step links at the top of the page. The user must complete every step before he or she can continue to the next step. A Cancel button is available in every step, so the entire process can be canceled at any time.

If Line of Business specific boilerplate text has been configured, this page will display text items according to the Line of Business of the Authorization form that is selected.

Form

In the first step the user selects the Authorization form.

Field Description

Form

The possible Authorization forms (categories) of an Authorization to choose from

If only one Authorization form is configured in the system then this form will be selected automatically and cannot be changed. The image below shows the first step for a configuration with more than one Authorization form (that is, not automatically selected).

New *Authorization* Form

Specifics

In the second step the user can add the following fields related to the authorization:

Field Description

Brand

The Brand to which the Authorization belongs

Type

The Authorization types are 1) Authorization 2) Notification 3) Referral (mandatory)

Code

The Code of the Authorization. The field is pre-filled with a generated Code that can be overwritten by the user.

Requested by Provider

The Provider requesting the Authorization for services

Requested by Relation

The Person or Organization requesting the Authorization for Services

Requested for

The Insurable Entity Type and the Code of the Insurable Entity for which the Authorization is requested (two fields, both mandatory)

Requester Reference

The number or Code used by the requester to identify the Authorization

Service Provider

The Provider delivering the specific Services to the Person or object

Provider Group Scope

The scope with respect to Provider Groups (In, Out or Either)

Service Specialty

The Specialty for which the Authorization is requested

Location Provider

The Location at which the Services will be provided

Requested Renewal Reference

The Requested Renewal Reference (Calendar Year, First Claim or First Claim Irregular)

Requested Renewal Period

The Requested Renewal Period length and unit of measure (Day, Month or Year)

Currency

The Currency of all Amount fields

Requested Amount

The total Amount for which Services are requested including Currency

Requested Units

The number of Services for which the Authorization is requested

Requested Service Days

The number of Service days for which the Authorization is requested

Start Date

The Start Date of validity of the Authorization

End Date

The End Date of validity of the Authorization

Remarks

Additional information for internal use

Access Group

The data access group that controls the access to the Authorization in the UI pages

Dynamic Fields

Dynamic fields configured for Authorizations

New Authorization Specifics

A Currency Code can be keyed in to denote that all Amount fields should be given that Currency. If a Currency Code is not provided for, the default Currency will be used instead. Note that the Currency field for requested Amount cannot be updated directly.

Service Types

In this step the user can add the service types for which the Authorization is intended.

Field Description

Service Type

The service type

Dynamic Fields

Dynamic fields configured for Authorization service types

new authorization service types

Lines

In this step the user can add Authorization Lines for which the Authorization is intended.

Field Description

Code

The Code of the Authorization Line; when left blank the Code will be generated using the Authorization Line Code Generation dynamic logic function or using the sequence of the line within the Authorization if the Code generation function is not configured

Procedure

The Procedure that is the subject of the Authorization Line

Procedure Group

The Procedure Group that is the subject of the Authorization Line

Requested Renewal Reference

The Requested Renewal Reference (Calendar Year, First Claim or First Claim Irregular)

Requested Renewal Period

The Requested Renewal Period length and unit of measure (Day, Month or Year)

Requested Amount

The Amount for which the Authorization line is requested including Currency

Requested Units

The number of units for which the Authorization line is requested

Requested Service Days

The number of service days for which the Authorization Line is requested

Start Date

The Start Date of the Authorization Line

End Date

The End Date of the Authorization Line

Dynamic Fields

Dynamic fields configured for Authorization Lines

New Authorization Lines

Note that the Currency field for requested Amount cannot be updated directly.

Diagnoses

In this step, the user can add the diagnoses for which the Authorization is intended.

Column Description

Diagnosis

The Diagnosis that is the subject of the Authorization

Dynamic Fields

Dynamic fields configured for Authorization diagnoses

New Authorization Diagnoses

View and Save

In this step, the user can view all the details that have been added in the previous steps. The following read-only sections are displayed:

Section Description

Form

In this section the following field is displayed:

  • Form

Specifics

In this section the following fields are displayed if they have a value:

  • Brand

  • Type

  • Code

  • Requested by Provider/Relation

  • Requested for (displays two separate fields:Type and Code)

  • Requester Reference

  • Service Provider

  • Provider Group Scope

  • Service Specialty

  • Location Provider

  • Requested Renewal Period including reference

  • Currency

  • Requested Amount including Currency

  • Requested Units

  • Requested Service Days

  • Start Date

  • End Date

  • Remarks

  • Access Group

  • Dynamic Fields

Service Types

The details about Authorization service types are displayed (this section is shown only if service types are added). The following fields are shown per service type if they have a value:

  • Service Type (code and description)

  • Dynamic Fields

Lines

The details about Authorization Lines are displayed (this section is shown only if lines are added). The following fields are shown per Authorization line if they have a value:

  • Code

  • Procedure (Code and Description)

  • Procedure Group

  • Requested Renewal Period including reference

  • Requested Amount including Currency

  • Requested Units

  • Request Service Days

  • Time Validity

  • Dynamic Fields

Diagnoses

The details about Authorization diagnoses are displayed (this section is shown only if Diagnoses are added). The following fields are shown per Authorization diagnosis if they have a value:

  • Diagnosis (code and description)

  • Dynamic Fields

If changes are required, the user can choose to navigate back to any step in the process by using the Back button or the links at the top of the page. If no changes are required, the user needs to click on the Finish button to end the wizard and save the new Authorization. The new Authorization will be saved with status Entry and the View and Edit Authorization page will be opened in the context of the new Authorization.

New Authorization View and Save