Authorisation
Find a Member
This is the main section of Authorisation and is how you search for membership or pre-authorisation details for a specific patient. As well as seeing all the info about existing pre-authorisations relevant to your organisation, you’ll also be able to request new ones.
Click the Records & Reporting tab, then Find Member & Pre-Auth.
Click on Find a Member or press A on your keyboard. This section is split into two, the top shows the insurers that offer both pre-authorisation and membership details, the bottom are those that only offer membership details. For the insurers that only offer membership details read our Find Member guide.
Pre-Authorisation & Membership Details
- Click on the insurer or press the corresponding letter
- Using your mouse to click into each field or pressing the tab key on your keyboard, complete the insurer’s mandatory fields as a minimum – these’ll be marked with an asterisk:
- First Initial
- Last Name
- Sex
- Date of Birth – you can either type this in or use the date picker
- Postcode
- Membership Number
- Group ID
- Policy Active On – by choosing the date of treatment you can make sure the policy will be valid
- Click Search or press Enter on your keyboard
- You’ll get an instant response – details of what you’ll see can be found in our Find Member guide
If there’s a match, you’ll see three boxes. On the left is a list of any pre-authorisations already available for that patient – it’ll default to the top, but you can scroll down to select the one you need or use the filter options. On the right at the top are the patient’s membership details and beneath that the details of the selected pre-authorisation.
The pre-authorisation details section has the following info at the top of the card:
- Case Code
- Patient Diagnosis
- Authorisation code – with additional badges showing:
- Whether the pre-auth is Active or Closed
- Who the current action is with – either With insurer or With provider
- Whether the pre-auth has been Read or Unread (you can also choose to mark a pre-auth as Unread)
- Requested on date
- Issued on date
- Last updated date
There are three tabs: Services (default view), Notes & Messages and Attachments.
Services
This section displays important pre-authorisation details:
- Services – showing the service
- Treatment Date – showing the valid from and to period
- Authorisation – showing the valid from and to period for the approved treatment
- Setting – whether Daycase, Inpatient or Outpatient
- Inpatient Nights – the maximum number authorised
- Laterality – what side of the body the procedure is to be performed on
- Status
- Treatment Sites – the approved treatment site(s)
- Practitioners – the approved treatment provider(s)
- Procedures – the approved procedure(s)
You can easily copy any info by clicking on the icon next to it – handy if you want to paste it into another system.
Notes & Messages
There’ll be an indicator next to the title if there’s anything associated with this pre-authorisation.
Attachments
If any attachments have been uploaded you can view them here – again there’ll be an indicator next to this if there are any.
Requesting a new pre-authorisation
Please remember that receiving a pre-authorisation from the insurer is not a guarantee of payment – it simply means that the patient’s policy allows them to have the requested treatment.
Click the button + Request new authorisation at the top-right of the screen. You’ll be asked if you want to request a new authorisation for the selected member (their details will be shown on the button) or for someone else. If clicking for someone else you’ll be taken back to the original Find a member screen, except this time you’ll only see the insurers who offer the pre-authorisation service.
If you’re requesting for the selected member, you can click on a specific treatment case if there are any previous ones showing and the new request is relating to one of those. If not, click + Create new.
Complete the relevant details – the mandatory fields are marked with an *:
- Patient diagnosis
- Service items:
- Service code* – choose from the available options for that insurer – if you hover over one of the options in the dropdown menu, you’ll see what’s included in that service (if what you’re needing isn’t there either you or the patient will have to contact the insurer directly)
- Settings* – if you choose inpatient the number of nights will be automatically calculated from the insurer guidelines
- Laterality – indicate whether the left or right side of the body is to be operated on or bilateral
- Procedures – easily search by text or code and choose from the dropdown, the procedure will show underneath the box and you can click on the cross to remove it – you can choose multiple procedures by repeating the process
- Treatment start and end date*
- Controlling practitioner details – search by First name, last name or by their registered body membership number e.g. GMC number
- Treatment site*
Click Add service and this’ll create a new service.
- Add a message to this request: does what it says – you can add a message for the insurer to this request
- Add attachment to the request: upload anything that’s required to support the request e.g. clinic letter
To get back to the main screen just click on the Home icon at the top left of the screen. Any searches that’ve been done today by anyone in the organisation will be shown on the right-hand side. You can click these at any point throughout the day to view the results again.
