Billing Authorizations Process

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Billing Authorizations Process by Mind Map: Billing Authorizations Process

1. Clinician completes ARTS Screening

1.1. Paper or Electronic on the Official ARTS Screening Form > do BOTH the Official Version and the ECR version.

1.1.1. OFFICIAL VERSION = Paper Version > is printed form the official Magellan website:

1.1.1.1. Option: Downloaded and typed in Word

1.1.2. Electronic Version > is in ECR

1.1.2.1. Word Document version is Copy/Pasted into the ECR Version

1.1.3. SIGNATURES REQUIRED: by "Paneled Provider" (currently Rick or Stephanie)

1.1.3.1. Jan Adds a "statement" of: "Approved by Rick Mitchell, LPC, LSATP - on [date]

1.1.3.2. Jan Spencer > emails the Official Version to Rick (as a Word document) - then Rick signs it via his phone and emails it back to Jan

1.1.3.2.1. Jan FAXES the Initial Authorization with Rick's signature to the MCO.

1.1.3.2.2. Jan prints ARTS Screening Document (with Rick's signature) and places into Catalyst Box (front office) for Jerry Cohan to sign (usually Wednesdays).

1.2. QUESTION: Does Jan get Jerry to sign off on Extension Requests? No, Jerry does not sign off on ext. requests.

2. Authorization Approved

2.1. Date Range, Units and Authorizations Number are entered into ECR - under Authorizations Tab (by clicking on Residents name)

2.2. The Copy of the Authorization is scanned and uploaded into the ECR Chart under "Correspondence"

2.3. Authorization is added to the Authorizations Folder in [Excel?] for Carrie (inside of Sharepoint)

2.4. Individual auth uploaded to SharePoint under authorization tab then under whichever MCO tab that is applicable.

2.5. Enter into patient's chart in ECR under authorization tab

2.6. Upload auth in One Drive for clinical to track

2.7. Upload auth to Sharepoint for Carrie's review if needed

3. Maintaining Authorizations

3.1. Tracking when the next Authorization is "Due"

3.1.1. Assigned Clinician TRACKS when Authorization is Due

3.1.1.1. Either plans a Discharge

3.1.1.2. OR - Submits an ARTS Extension Request

3.2. Pro

3.3. Con

3.4. When authorizations are received via fax , phone or mail they are entered on authorizations in One Drive for therapist to track when next auth. is due.

4. Extension Requests

4.1. Lead Clinician completes ARTS Extension Request Form in Word within [x]-days of "end date of previous authorization"

4.2. Electronically (Word doc) send to Jan

4.3. Jan Tracks (how?) when sent to the MCO

4.4. ENTER INTO APPROVAL LOOP

4.4.1. Either Approved or Denied

4.5. Pro

5. Carrie Notes

5.1. Pro

5.2. Con

5.3. Con

6. AUTHORIZATION RECEIVED - METHOD

6.1. FAX

6.1.1. Coming in currently through "Dillon Ferguson" extension

6.2. EMAIL from the MCO

6.3. PHONE CALL

6.3.1. If by phone - then Jan asks for a FAX; Date Range, Number of Units, and Authorization Number

6.4. **Gets Entered into ECR as an "Insurance Coordination Note"

6.5. Then, Units get entered into the Authorizations Tab in ECR

6.6. IF Authorization is Denied > then "note this" in [which SharePoint files] >> check this weekly