Skip to main content

​
At a Glance

Prior authorization must be present in many circumstances in order for insurers to pay out claims. This guide details where to enter and update this information in Insights.

​
What Is Prior Authorization?

Before providing treatment or prescribing medication, physicians need to obtain approval from an insurer. This tactic, used by insurance companies to control costs, is called prior authorization. Without prior authorization, a health plan may not pay for treatment or medication. Emergency care doesn’t need prior authorization.

​
Here is the Prior Authorizations page.

You can access it via the header of the list of encounters on the Encounter Details page. Click the ‘Prior Authorizations’ button.

​
Page Header Features

At the top of the Prior Authorizations page, you can…
  • Set filters to show you only certain authorizations. For example, you can filter for a particular patient or authorizations set to expire by a certain date.
  • Download a CSV file so you can view the data in a spreadsheet.
  • Create a new authorization. Just below the page header, you can click the following column headers to re-sort the list of authorizations in either ascending or descending order:
  • Total Visits/Units
  • Remaining Visits/Units
  • Effective Date
  • Expiry Date These walkthroughs focus on how to add or update prior auth through this page only.

​
How to Add a New Prior Authorization

We’ll begin by clicking Create Authorization. A window will appear with fields for you to fill out. Pro Tip To expedite your search in many fields throughout Insights, begin typing out the entity for which you’re searching and select it when it appears in the list. Fill in the patient name, authorization type (pre-certification or referral), auth number, and effective and expiration dates. You can choose to track prior auth by visit count or CPT code unit count. For this example, we’ll select visit count. Add any notes that would be useful for colleagues looking for information about this authorization. You can select or create any tags you like, which can help keep your authorizations organized. Click Create and you’re done! You can now see your new authorization in the table. It may help to filter for it if there are many other authorizations.

​
How to Update Existing Prior Authorization

Filter for the authorization you would like to update and click the pencil icon. Make any adjustments you like to the authorization. For this example, we’ll change the tracking type from visit count to CPT code and unit count. Then, we’ll click Update. The new information is now displayed for that authorization.

​

​
Other Ways to Update Prior Authorization in Insights

You can update prior auth in two other places in Insights:
  • The ‘Prior Authorizations’ tab on the patient’s profile