Request pre-authorisation

Available to

Billing officers.

A pre-authorisation is the payer's approval, before the service, to pay for an expensive or restricted service.

Open Insurance → Pre-authorisations and select New.
Choose the Patient, Coverage (it must belong to the same patient), Facility and Service Kind. Add the Encounter and Product if known.
Enter the Requested Amount and the Description of the service.
Send the request to the payer, then select Mark Submitted.
When the payer replies, select Record Approval and enter the payer's Approval Number, the approved amount and the validity dates, or select Record Denial and enter the Denial Reason.

State	Meaning
`Draft`	Being prepared.
`Submitted`	Sent to the payer.
`Approved`, `Partially approved`	The payer approved all or part of it.
`Denied`	The payer refused.
`Expired`, `Cancelled`	No longer usable.

An approval needs the payer's approval number and the start date.
The Used Amount shows how much has been consumed by claims. An authorisation that claims have used cannot be cancelled.
A plan can block elective surgery without pre-authorisation. A surgical case is then refused until one is approved.