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Adding Prior Authorizations to Claims

This article covers the process of how to add Prior Authorizations to an Account's ledger, and subsequently how to include those Prior Authorizations to an Insurance Claim. If you're looking for more generic information on how to create an insurance claim, you can click here.

Adding a Prior Authorization to an Incident

Before a Prior Authorization can be used on an Insurance Claim, it must be added to a patient's Incident in the Ledger Tab of the Patients Ability. Once you're in the Ledger Tab, you can either click the Incident node (the Folder icon) in the Ledger sidebar:

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Or you can add a new Incident by clicking the Incidents drop down menu and clicking "New Incident":

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Click here for more information about setting up an Incident.

Once the desired Incident is selected, you can navigate to the Prior Auth. claim in said Incident, and click the Green Plus in the upper right hand corner to add a new Prior Authorization line to the table. The Patient MUST have Insurance added to their account via the Primary/Secondary Tab before you can add a Prior Authorization.

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There are a few columns you'll want to fill out.

  • The Prior Authorization column indicates the Authorization number or identifier of the Prior Authorization.
  • The Insurance drop down allows the user to select which Insurance company gave the Prior Authorization.
  • Total Visits allows the user to set a maximum number of times this Prior Authorization can be used. When initially set, the Remaining Visits field is automatically set to match, and will also deplete automatically when this Authorization included in a Claim.
  • Expiration Date is when this Prior Authorization ends.
  • Start Date is when this Prior Authorization can begin to be used.

Once you've filled out these fields, press Command-S to save.

Including a Prior Authorization to a Claim

When creating an Insurance Claim, you'll want to make sure that the "Prior Auth" column has the Prior Authorization that you created in the previous step selected in the drop down. By doing this, the Prior Auth will be included in Box 23 of the CMS Claim form and Box 2 of the ADA Claim Form.

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And that's it! If you have any further questions, feel free to contact MacPractice Support.

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