Pre-authorisations

The insurer's approval for each insured admission (Insurance pre-authorisation add-on): the request with the member and policy numbers, the diagnosis and the estimated cost, the insurer's queries, the approved amount and approval number, more asked for a longer stay, the final bill and the settlement. The board lists the open requests longest wait first, with each insurer's approved, billed, settled and disallowed amounts.

Steps

  1. Open Pre-authorisations and press New request. Pick the patient's bed (the IP number, name and admission day fill in) or type them, then the insurer or TPA, the member and policy numbers, the diagnosis and the estimated cost, and send it.
  2. When the insurer asks something, press Insurer query and write the question; press Query answered once you reply. When it approves, press Approved with the approved total and the approval number.
  3. If the stay runs longer, press Ask for more with the new total, then Approved again when the insurer agrees. An approval never goes down.
  4. At discharge press Send final bill with the bill's total; what is above the approval is the patient's share. When the insurer pays, press Settled with what it paid: the rest of the approval shows as disallowed. Press Rejected with the insurer's reason if it refuses.

Tips

  • A request or query that has waited over a day for the insurer is marked Chase the insurer. The Insurers tab shows what each one approved, was billed, settled and disallowed.
  • Each step keeps who recorded it, when, its amount and note, and settled, rejected and cancelled requests no longer change.
  • Ask StartAI which requests are waiting or how much an insurer disallowed, or tell it an approval came in: it records the step after you confirm. It never reads the diagnosis.

In the app, press F1 or ? on this screen to open this guide next to your work.

This guide belongs to the Insurance pre-authorisation module. Learn more

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