PreAuthorization Request

Tarun January 27, 2021

You are never able to Request a PreAuthorization without completing a Benefit Check request first.
If a patient’s Medical plan does Not Require/Allow a PreAuthorization for a service/procedure, it Cannot be Forced. Medical plans have their own guidelines on what service/procedure needs a Pre Auth/Pre Determination/Pre Certification and it may be different even if two patients have the same Insurance company, their Group may have separate requirements.
You will choose a “Date of Service” for a Pre Authorization as a Target Date, just like you did for the Benefit Check. If you do Not have a target date, you can just choose tomorrow’s date as a placeholder, it will Not affect your Pre Authorization or Claim.
You will only be Required to submit a file/document when you see the red “Required” word next to one of the sections labeled “X-Ray” or “Periodontal Chart/Other”. After you click the “Choose Files” button and browse/open the file that is Required, make sure to click the green “Upload All” button, where you will see a progress bar of the file being Uploaded, then when it is complete, the red “Required” will disappear. You will Not be able to Save/Process a Pre Authorization Request until all red “Required” notifications have disappeared/satisfied.
As noted in the video, even when there is No red “Required” word for the procedure code you chose, you can still choose to upload documents that you think are relevant to the case. Examples: ER/Hospital/Police reports for trauma/injury cases, Photos showing chipped teeth, Referral letters from an M.D. or an ENT.
All your Pre Authorization requests are saved on the grey menu/tab “Prior Authorization”. All new Pre Authorization requests will have a status of “Not Reviewed” and will updated to “Prepped” or “Submitted” after a CODE team member has reviewed your SOAP notes and has called/faxed in the Pre Authorization request on your behalf.
Some Pre Authorization cases may take 10-14 days for the Insurance plan to make a decision of Approved or Denied. Your office and patient should receive a letter about the decision. But if you do not receive an Insurance response after 14 days, you may request a Pre Authorization status by creating a Topic on the Document Management message board.
When the CODE team is notified by you that you received a letter or the Insurance plan called the CODE office about the Decision, we will update the status to “Completed” and include a note about an Approval # with a Date Range or a reason for the Denial of the case. You will always get an email notification about a Completed Pre Authorization, you do not have to check the Prior Authorization tab/menu every hour/day.