View and Edit Authorization

When clicking on an Authorization Code link in the Authorizations Search page (described in Authorizations Search), a View and Edit Authorization page is opened where the user can view and edit the selected Authorization. This page is also opened in the context of a new Authorization, after finishing the wizard for the creation of a new Authorization in the New Authorization page (described in New 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. If insurance type specific boilerplate text has been configured, this page will display text items according to the insurance type of the Authorization form.

The page is divided into five different sections:

• Header and Buttons

• Authorization Messages

• Authorization Attributes

• Service Types, Baskets, Lines and Diagnoses

• Actions and viewing details based on Authorization status history

All sections are read-only; updates to the Authorization are performed in detail dialogs. These sections are described below in separate paragraphs (including the specific section mock-ups).

The mock-ups below show the View and Edit Authorization page in different scenarios, all only having a single version:

• An Authorization that has the Entry status

• An Authorization that has the Pended status

• An Authorization that has the Change status

• An Authorization that has the Approved status

For multiple Version Authorizations, the Version is shown in the header and other Versions can be accessed through a drop-down, as is shown in the following mock-up of an Authorization in Approved status:

Header and Buttons

The header of the page displays the Authorization Code, the Version of the Authorization and the status of the Authorization. The Version is only displayed if there is more than one Version for an Authorization. If the Authorization is Pended, the process step in which the Authorization is Pended is also shown in the header. If the Authorization has stopped processing due to a technical error, a Processing Error link appears under the header. Clicking it opens the View Technical Errors page in the context of this Authorization, where the user can reprocess the technical error.

The following items are displayed at the top of the page:

Table 1. Header and Buttons

Item	Description
Show (drop-down list) and Go To (icon)	The Show drop-down list provides access to other versions of the Authorization. It is only displayed if there is more than one Version for an Authorization. The Version in context is not displayed in the list. Selecting a Version and clicking on the Go To icon will open the selected Version in the same tab.
Refresh (icon)	Clicking on this icon will refresh the page. It is only displayed for the newest Versions of Authorizations.
Delete (icon)	Clicking on this icon will delete the Authorization (after first displaying a Warning dialog). Only Authorizations that never have been submitted for processing can be deleted so this icon is only displayed for the Authorizations that still have the Entry status.
Save (button)	Clicking on this button will save all outstanding changes. It is only displayed : To the users that have an access restriction grant with Create, Update and/or Delete rights for the View and Edit Authorization page for the Authorization in the Entry or Change status To the users that have an access restriction grant for the access restriction type Attached Data for the Authorization in any status Note that the changes made in detail dialogs - Update attributes, Update Service Types, Update Baskets, Update Lines, Update Diagnoses, Update attached data are not saved until the Save button is clicked.
Cancel (button)	Clicking on this button will cancel all outstanding changes. It is only displayed : To the users that have an access restriction grant with Create, Update and/or Delete rights for the View and Edit Authorization page for the Authorization in the Entry or Change status To the users that have an access restriction grant for the access restriction type Attached Data for the Authorization in any status

Authorization Messages

The Authorization Messages section is displayed under the header of the page. Authorization messages are stored during the processing of the Authorization or are added by the user.

The section is only displayed if the Authorization has one or more Authorization messages that are configured not to be suppressed in the user interface. A maximum of two messages (Severity, Code and message text) are displayed (messages with the highest priority). There is a link (More) under the messages that opens an Authorization Messages detail dialog showing all messages on the Authorization and allowing data manipulation on them.

The detail dialog has the following columns:

Table 2. Authorization Messages

Column	Description
Severity	The Severity of the message: Informative or Fatal.
Priority	The priority of the message.
System Specific?	Is the message system specific?
Code	The Code of the message.
Text	The message text.
Inherit?	Should the message be inherited by the Claim Line in Claims?

Authorization Attributes

The Authorization Attributes section is displayed under the Authorization Messages section. This read-only section displays the following fields (if they have a value):

Table 3. Authorization Attributes

Field	Description
Form	The possible Authorization forms (categories) of incoming Authorizations to choose from
Brand	The Brand to which the Authorization belongs
Type	The Authorization types are 1) Authorization 2) Notification 3) Referral
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)
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
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 Period	The Requested Renewal Reference
Renewal Period	The Requested Renewal Period length and unit of measure
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
Authorized Amount	The total Amount for which Authorization is Approved including Currency
Authorized Units	The number of units for which the Authorization is Approved
Authorized Service Days	The number of days for which the Authorization is Approved
Override Cover Limits?	Should the adjudication cover stop limits be overridden if this Authorization is applied in Claims?
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

Service Types, Baskets, Lines, and Diagnoses

These sections are read-only. Updates on Authorization service types, Authorization Baskets, Authorization Lines or Authorizations Diagnoses are possible through Update actions on them. Updates are only possible when the Authorization is in the Entry or Change status (this is described in detail in a later section).

Service Types

This sub-section is displayed when at least one Authorization service type is defined. The following information is shown for each Authorization service type:

Table 4. Service Types

Field	Description
Service Type	The Code and description of the service type
Dynamic Fields	Dynamic fields configured for Authorization service types and having a value

Baskets

This sub-section is displayed when at least one Authorization Basket is defined. The following information is shown for each Authorization Basket:

Table 5. Baskets

Field	Description
Basket	The Code and description of the basket
Time Validity	The Start and End date of the Authorization basket
Dynamic Fields	Dynamic fields (having a value) configured for Authorization Basket

Lines

This sub section is displayed when at least one Authorization Line is defined. The following information is shown for each Authorization Line (when having a value):

Table 6. Lines

Field	Description
Code	The Code of the Authorization line
Procedure	The Code and Description of 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 Period	The Requested Renewal Period length, unit of measure and reference
Renewal Period	The Renewal Period length, unit of measure and reference
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
Authorized Amount	The Amount for which the Authorization line is approved including Currency
Authorized Units	The number of units for which the Authorization is Approved
Authorized Service Days	The number of service days for which the Authorization Line is Approved
Time Validity	The Start and End Date of the Authorization Line
Dynamic Fields	Dynamic fields configured for Authorization Lines

Diagnoses

This sub-section is displayed when at least one Authorization Diagnoses is defined. The following information is shown for each Authorization Diagnoses:

Table 7. Diagnoses

Field	Description
Diagnosis	The Code and Description of the Diagnosis that is the subject of the Authorization
Dynamic Fields	Dynamic fields configured for Authorization Diagnoses and having a value

Actions and Other Details

Based on the Authorization status and access restrictions, the user gets access to the following actions:

Table 8. Actions and Other Details

Status	Other Details/Actions
	Entry
	Submit Authorization
	Update attributes
	Update service types
	Update baskets
	Update lines
	Update diagnoses
	Update messages
	Update/View attached data
Change	Pend reasons
	Unfinalize reason
	Submit Authorization
	Update attributes
	Update service types
	Update baskets
	Update lines
	Update diagnoses
	Update messages
	Update/View attached data
	View status history
Pended	Pend reasons
	Un-finalize reason
	Resolve pends and submit
	Edit Authorization
	Deny Authorization
	Update/View attached data
	View status history
Approved / Denied	Un-finalize reason
	Un-finalize Authorization
	Update/View attached data
	View status history
In Process	Un-finalize reason
	Update/View attached data
	View status history

Actions

Update Attributes

Clicking on this action opens an Authorization Attributes detail dialog where the user can update the attributes of the Authorization. The detail dialog consists of all the fields described in the "Authorization Attributes" section and the Code of the Authorization plus dynamic fields; dynamic records are shown in the top right hand corner of the detail dialog.

Note that the Code of the Authorization can be updated only if the Authorization is in the Entry status. The Authorization form cannot be updated.

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. That way, it’s only necessary to specify a Currency Code when deviating from the default Currency Code. Later updating the Currency Code will automatically lead to a cascade update of the appropriate Amount fields. Note that the Currency fields for requested and authorized Amount cannot be updated directly.

Update Service Types

Clicking on this action opens an Authorization Service Types detail dialog where the user can add/delete/update the Authorization Service Types. The following fields are available:

Table 9. Update Service Types

Field	Description
Service Type	The Service Types that is the subject of the Authorization
Dynamic Fields	Dynamic fields configured for Authorization Service Types

Update Baskets

Clicking on this action opens an Authorization Baskets detail dialog where the user can add/delete/update the Authorization Baskets. The following fields are available:

Table 10. Update Baskets

Field	Description
Basket	The Basket that is the subject of the Authorization
Start Date	The Start Date of the Authorization Basket
End Date	The End Date of the Authorization Basket
Dynamic Fields	Dynamic fields configured for Authorization Baskets

Update Lines

Clicking on this action opens an Authorization Lines detail dialog where the user can add/delete/update the Authorization Lines. The following fields are available:

Table 11. Update Lines

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 Code and Description of 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)
Renewal Reference	The Renewal Reference (Calendar Year, First Claim or First Claim Irregular)
Renewal Period	The 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
Authorized Amount	The Amount for which the Authorization line is approved including Currency
Authorized Units	The number of units for which the Authorization Line is Approved
Authorized Service Days	The number of service days for which the Authorization Line is Approved
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

Dynamic records are shown in the top right hand corner of the detail dialog. Note that the Currency fields for requested and authorized Amount cannot be updated directly.

Update Diagnoses

Clicking on this action opens an Authorization Diagnoses detail dialog where the user can add/delete/update the Authorization Diagnoses. The following fields are available:

Table 12. Update Diagnoses

Field	Description
Diagnosis	The Diagnosis that is the subject of the Authorization
Dynamic Fields	Dynamic fields configured for Authorization Diagnoses

Update Messages

Clicking on this action opens an Authorization Messages detail dialog where the user can add non system specific message or delete/update messages that are not added by the system during Authorization processing.

The following fields are available:

Table 13. Update Messages

Column	Description
Severity	The Severity of the message: Informative or Fatal.
Priority	The Priority of the message.
System Specific?	Is the message System Specific?
Code	The Code of the message.
Text	The message Text.
Inherit?	Should the message be inherited by the Claims Lines in Claims system?

Update Attached Data

Clicking on this action opens an Attached data detail dialog where user can add additional information about the Authorization without affecting the Authorization status or processing. Attached data is not specific to an Authorization version, it is attached at the level of an Authorization.

Attached data is displayed as shown in the image below. First the dynamic fields are shown, followed by the dynamic records.

For the uses that do not have access to modify attached auth data, the detail dialog opens as read-only.

Submit Authorization or Resolve Pends and Submit

Clicking on this action saves and submits the Authorization for processing. The system may resolve the Pend Reasons (when present) depending on the access restrictions the user has and the point in the process flow from where the Authorization is submitted. This is described in detail in the chapter Authorization Processing, section Submit Authorization

Edit Authorization

When the user has update access on the Authorization, then clicking on this action opens the Authorization in the Change status in the same tab. Note that the Authorization is not automatically saved in Change status; the user still has the possibility to cancel the edit action by using the Cancel button in the header section of the page. The user edits the Authorization and can select to Save, Cancel or Submit it for processing.

When user has only Pend Resolution access, but no update access, then clicking on this action automatically saves the Authorization in the status Change and opens it in the same tab (view only).

Deny Authorization

Clicking on this action opens a message detail dialog where the user can select a reason (fatal message) for the denial of the Authorization. The detail dialog shows all the fatal messages from which the user can select one of the message that best suits the action. On clicking OK the Authorization will be submitted for processing denial.

Un-finalize Authorization

This action is only displayed for the last Version of an Authorization in status Approved or Denied.

Clicking on this action opens an Unfinalize Reason detail dialog where the user can select an Unfinalize Reason.

The detail dialog shows all the Unfinalize Reasons from which the user can select one of the reasons that best suits the action. Un-finalizing leads to a new Version of the Authorization plus its details (with the exception of processing messages); the Unfinalize Reason is attached to the new Version.

On clicking OK the system opens the Authorization in the Change status in the same tab if the user has update access on the Authorization. Note that the Authorization is not automatically saved in Change status; the user still has the possibility to Cancel the unfinalize action by using the Cancel button in the header section of the page. The user edits the un-finalized Authorization and can select to Save, Cancel or Submit it for processing.

When user has only Authorization Un-finalization access, but no update access, then clicking OK action automatically saves the Authorization in the status Change and opens it in the same tab (view only).

Other Details

Pend Reasons

The Pend Reasons (Code and Description) are displayed below this label grouped by the process step.

The system displays the Pend Reasons as grayed out 1) when a user does not have access to resolve the Pend Reasons (refer to the mock-up for the Authorization in status Change ) or 2) the Pend Reasons cannot be resolved in the current Pended process step as they belong to a different process step (refer to the mock-up for the Authorization in status Pended)

Un-finalize Reason

If the Authorization has been unfinalized, this label is shown and below it the Unfinalize Reason is displayed. The Code and description of the Unfinalize Reason are shown. The Unfinalize Reason attached to the shown Version of the Authorization is shown (which was added when unfinalizing the previous to shown version).

View Status History

Clicking on this link opens an Authorization status history detail dialog. The dialog consists of three sections:

• Section one showing the status history - the status transition details

• Section two showing the details about the Authorization pend history associated to the status history (Pended and Change)

• Section three showing the applied rule history. This includes Callout Rules, Events Rules and Validations Rules executed during the processing (that is In Process status).

All the sections are display only and show the attributes in a table based layout.

The following fields are displayed:

Status History

Table 14. Status History

Field	Description
Date time	The date time when the Authorization entered the status
Status	The status

Pend History

Table 15. Pend History

Field	Description
Code	The Code of the Pend Reason
Description	The description of the Pend Reason
Resolved By	The user who resolved the Pend Reason

Applied Rule History

Table 16. Applied Rule History

Field	Description
Step	The step during which the rule was executed
Rule	Shows the details about the rule that was executed. The information that is displayed is based on the nature of the rule and is as described below: Callout Rule - Code, Description, Sent and Received Event Rule - Topic and Event Validation Rule - Code and Description