Completing the SP authorization prescreening
Complete the prescreening to learn the classification of an SP authorization request immediately.
In the first part of the authorization request process you provide prescreen information.
The prescreen evaluation can immediately provide you with the classification of an authorization request. If authorization is required, you can proceed with the workflow. If authorization is not required, or if another business evaluation occurs, a message informs you of the next action to take.
You might see messages while completing the Prescreen section. For more information about the messages, see Prescreen messages.
To complete the Prescreen section:
1. Select the service type from the Service Type menu.
2. Select the place of service from the Place of Service menu.
3. Specify the primary diagnosis using the following steps:
a. Enter a minimum of two characters in the Search by Diagnosis name or Search by Code, optionally choose a code set from the drop-down menu, and select Search.
Use precise criteria to get the best search results; only 50 data entries are shown per search.
If the characters you enter match a single record, the fields are filled in automatically and you can skip the next step.
If your search did not result in a match, a slider opens with search results. To refine your search, select Name contains or Name starts with, enter your new search term in Search by Diagnosis name or Search by Code, optionally select a code set, and select Search.
b. Choose the correct record (diagnosis name, code, code set) in the search results, scrolling through the list if needed.
The code set includes the diagnosis coding schemes defined in TruCare.
If necessary, select Clear to start over.
You might see a message about a diagnosis code being expired. For more information about expired codes, see Expired diagnosis or procedure codes.
4. Specify the primary procedure using the following steps:
Note: The fields may already include a default procedure code specified by your administrator for the selected service type. If you need to change the default procedure code, use these steps.a. Enter a minimum of two characters in the Search by Procedure name or Search by Code, optionally choose a code set from the drop-down menu, and select Search.
Use precise criteria to get the best search results; only 50 data entries are shown per search.
If the characters you enter match a single record, the fields are filled in automatically and you can skip the next step.
If your search did not result in a match, a slider opens with search results. To refine your search, select Name contains or Name starts with, enter your new search term in Search by Procedure name or Search by Code, optionally select a code set, and select Search.
b. Choose the correct record (procedure name, code, code set) in the search results, scrolling through the list if needed.
The code set includes the procedure coding schemes defined in TruCare.
If necessary, select Clear to start over.
You might see a message about a procedure code being expired. For more information about expired codes, see Expired diagnosis or procedure codes.
5. In the Requested Units field, type the number of requested units or use the scroll arrows to enter requested days.
The count must be at least 1 (one).
6. From the Unit Type menu, make a selection.
7. Enter the service start date in the format mm/dd/yyyy or use the date picker.
8. Enter the service end date in the format mm/dd/yyyy or use the date picker.
9. From the Member's Applied Eligibility menu, make a selection.
This field auto-completes when the member’s eligibility is on record.
10. Specify the servicing provider using the following steps:
a. Enter a minimum of two characters in the Search by Provider name or Search by Provider NPI and select Search.
If the characters you enter have a unique match, the fields are filled in automatically and you can skip the next step.
This search is checked against the full TruCare provider database. If you search using the dashboard provider filter, you are limited to only those facilities associated with your user account.
b. Select the provider from the list.
c. Select the provider specialty from the drop-down list (optional).
If the provider does not have a specialty, this field is not displayed. If the provider has only one specialty, the field is automatically populated with it.
If necessary, select Clear to start over.
11. Select Next.
The prescreen information is processed. If you can proceed with the authorization request, you automatically continue to the Authorization Details page, where you can add more details.
You might see a message with additional information about the request. Click Next again to continue to the Authorization Details page.
Sometimes the results of the prescreen evaluation prevent you from continuing with the authorization request, for one of the following reasons:
• Authorization is not required
• Duplicate request
• Review needed by a third party
• Member ineligibility
Select Cancel and then respond to the prompt to discard changes. Select Yes to return to the dashboard; select No to stay in the Prescreen page.
In the example below, the prescreen evaluation reports that “authorization is a duplicate” and instructs you to contact the payer. You cannot proceed.
