Create authorization request

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 to postpone sending.

Step 1. Click 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 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 Save & Send.
       A warning dialog appears informing that the request is sent to Shafafiya. 

Step 6. Click OK.

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

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

       Find Prior Authorization Requests form opens. 

Step 8. Select the request and click View.
       All data becomes disabled on Electronic Prior Request form. Payer reply section appears on 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:

• • transaction date;
  • transaction file name;
  • link to the file content.

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

ALTERNATIVE WORKFLOWS

Save authorization request as a draft

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

Create authorization request from Find Prior Authorization Requests form

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