Practices can create preauthorizations, similar to a claim, to send to insurance prior to completing any treatment in order to get an estimate of what is covered under a patient's insurance plan.
In the Treatment Plan Module, with desired procedures selected, click PreAuthorization.
A preauthorization is very similar to an insurance claim, except that when it is sent, the date of service is left blank. The insurance company reviews the procedures sent and decides whether they are covered under the patient's contract. They will send back a form with an estimate of how much will be covered for each procedure.
The Edit Preauthorization window is similar to the Edit Claim window. For details on fields, see Claim.
Other Coverage: If other coverage (e.g. secondary coverage) needs to be included when sending the preauthorization, Click Change next to Other Coverage and verify the Relationship to Subscriber. This option can also be used to set primary coverage if this is a preauthorization to a secondary insurance plan. If primary has already been received with no other coverage selected, send a new preauthorization for the secondary insurance only.
Preauthorizations for a patient are listed in the top right of the Treatment Plan Module. When a user clicks on a preauthorization, all procedures attached to that preauthorization will highlight for easy viewing.
Double-click a preauthorization to view details.
When the preauthorization comes back from insurance:
The estimates will flow into the patient's treatment plan estimates.
Check Preauthorization Status: Check the status in the upper-right of the Treatment Plan Module, or use the Outstanding Insurance Claims Report and include preauths.
Estimated write-offs cannot be entered when receiving a Preauthorization.
If Show Patient Responsibility column in the Edit Claim/Payment windows is enabled in Preferences, the estimated patient portion displayed on a Preauthorization may be higher than the actual patient portion if there are estimated write-offs or if the patient has other insurance coverage. The PatResp column is designed to show patient responsibility when receiving a claim.