Content Comparison

Prior Authorization is a request to the payer for approval of coverage for elective services/activities before the service is delivered. As well as an eligibility request, an authorization may be sent it to Post Office right away or saved to draft before to postpone sending.

Step 1. Click on Create New Prior Request button (or select  E-Prior New Prior Request or select Requests > New Authorization from the menu). 
       Electronic Prior Request - Authorization form opens. Patient Details tab is active.

Step 2. Select a patient using Find Patient field.

 
Step 3. Go to Request Encounter Details tab and enter the visit details (learn more).

Step 4. Go to Procedure Details tab and enter activities details (learn more).

Step 5. Click on  Save & Send button.
       A warning dialog appears informing that the request is sent to Shafafiya. 

Step 6. Click on OK button.

       Electronic Prior Request form closes. Menu The menu panel shows if there are new transactions to download.

Step 7. After the files the payer replied with are downloaded, click on  See today's authorizations.

       Find Prior Authorization Requests form opens. 

Step 8. Select the request and click on View button.
       All data becomes disabled on Electronic Prior Request form. Payer reply section appears on Request Encounter Details and Procedure Details tabs. Summary tab adds at the end. 

Step 9. Go to Summary tab.
       There are two sections: (1) the provider request summary and (2) the payer reply summary showing the following information:

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Note: Payer reply section shows no information if the request status is Waiting for approval as the reply hasn't been received yet.

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ALTERNATIVE WORKFLOWS

Save authorization request as a draft

1. Click on Create New Prior Request button.
   Electronic Prior Request - Eligibility form opens. Patient Details tab is active.
2. Select a patient using Find Patient field.
3. Go to Request Encounter Details tab and enter the visit details.
4. Go to Procedure Details tab and enter activities details.
5. Click on Click Save as Draft button.
   An information dialog appears saying that the request is saved into the database.
6. Click on Click OK button.
   Electronic Prior Request form closes.

Create authorization request from Find Prior Authorization Requests form

1. Click on Click Find Prior Requests button. 
   Find Prior Authorization Requests form opens.
2. Click on Click Add button.
   Electronic Prior Request - Authorization form opens. Patient Details tab is active.
3. Select a patient using Find Patient field.
4. Go to Request Encounter Details tab and enter the visit details.
5. Go to Procedure Details tab and enter activities details.
6. Click on Click Save & Send button.
   A warning dialog appears informing that the request is sent to Shafafiya.
7. Click on Click OK button.
   Electronic Prior Request form closes.

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