<p> -Client Authorizations</p><p>The Client Authorizations submodule in AlphaFlex is designed to allow easy access to the any client’s authorization information. This section syncs directly with the Authorizations tab in the Client Homepage (please the document titled, “Client Homepage” for further information), so anything done in this section will automatically update to that tab in real time. This submodule exists in the event the entity might have certain permissions on users that restrict them from accessing the entire Client Homepage (record) and/or have specific users only working client authorization records. The user can view authorizations currently in the system, update those records and/or add new authorizations all within this area of AlphaFlex. Client Authorizations</p><p>To open the Client Authorizations submodule, click on CLINICAL> Client Authorizations.</p><p>Once the screen opens, the user will see a list of filters to allow a client search. In the following pages, a review of how to search for clients, view, edit and add authorizations will be discussed.</p><p>Search for a Client -Client Authorizations</p><p>To begin working in this submodule, the user will need to look for a client. Just as with other “client searches” in AlphaFlex, the user can be very general (inserting one letter in the first name field) or very specific (typing the client’s first and last name) before clicking SEARCH. 1. Type in the information that known about the client to research.</p><p>2. Click SEARCH. *Please Note- The more information provided before clicking SEARCH, the more specific the result. For this example, the below will show the end result of searching by a full first and last name. </p><p>3. Click Select to the left of the Client ID and the authorizations for the selected client will appear in the bottom half of the screen. </p><p>Viewing Authorization Information -Client Authorizations</p><p>The bottom half of the authorization screen consists of all the details a user needs to answer any question in concern to a client’s authorization. The user will have the option to customize what is seen based on the four filters. As time goes on, the history of authorizations can get extensive, so AlphaFlex will allow the user to narrow down what is being viewed. The filters can be used on their own or in any combination with each other. The details are broken down below.</p><p> Auth. ID- input a specific authorization number in this field to search for one specific authorization.</p><p> Auth. Source- where the authorization originated. Manually Entered Auths are put in by the provider. AlphaMCS Auth are synced from MCO</p><p> Effective Date- the date the auth starts. *Note- this field will default to one month prior to the current day. </p><p> End Date- the date the auth ends. Note- this field will default to 12/31/2099.</p><p>Now that a client has been chosen and the desired filters have been set, the end result will be the actual authorizations. This information is set in a table format for ease of understanding and how to read that table is broken down below.</p><p> Insurance Authorization Number- the unique number assigned to the auth. This number can be assigned by the MCO (if auth is synced) or manually inputted by the provider.</p><p> Client- shows the client’s last and first name.</p><p> Insurance- displays the insurer that the authorization designated.</p><p> Service- will display either a single service code -OR- a set of services (service definition).</p><p> Mod1- will show data if the Service in the Service column contains any modifiers.</p><p> Mod2- will show data if the Service in the Service column contains any modifiers.</p><p> Effective Date- the first day of the authorization.</p><p> End Date- the last day of the authorization. -Client Authorizations</p><p> Is MCO Auth?- if the authorization synced with an MCO and that MCO sent the details to AlphaFlex, the user will see, “TRUE” for “yes”. If this authorization was manually inputted by the provider, the user will see, “FALSE” for “no”.</p><p> Active- the status of the authorization at the current time. True = yes. False = no.</p><p> MCO Synced Units- the number of units used as per the MCO. -Client Authorizations</p><p>Adding an Authorization The provider has the ability to add authorizations to the client record when and if the service being performed needs to have a valid authorization for overall approval. Starting from the point where a client has been searched and selected. 1. Click on Add Authorization. 2. The user will see a popup window where required and optional information will be added. </p><p>3. Choose the Insurance (based on what is in the client record), the Site and input an Insurance Authorization Number (see step 9 if there isn’t an Insurance Authorization Number as of yet). 4. Enter either a Service Definition OR a Service code. *Note- the Service Def. field will gray out because a Service was chosen in this example</p><p>5. Enter a Diagnosis if needed as this is not required. 6. Enter the number of units to authorize for the service.</p><p>7. Enter the date range the authorization will cover. *Note- the user can click the calendar icons in the right of the date fields to have a “date picker” appear. -Client Authorizations</p><p>8. Fill out any optional allotments for Daily, Weekly, Monthly, Yearly and LifeTime if necessary. 9. Confirm the Auth. Letter Recd. Box. *Note- If you do not have the authorization number yet, you can uncheck the Auth Letter Received checkbox. This allows clinicians to do everything they would if there was a number inputted—submit notes, have them reviewed and financially approved—but it stops the claim from actually being billed until you have the authorization number and the checkbox is checked and saved again. 10. Confirm the Active box is checked. </p><p>11. Click SAVE. 12. The authorization is now entered and notes can be submitted against this auth.</p><p>Important- Due to this authorization being manually inputted, the provider can go back and alter it if needed. Notice that the “Is MCO Auth?” column is marked FALSE. Only manually inputted auths can be edited by the provider. -Client Authorizations</p><p>Edit an Authorization Authorizations that are manually entered can be corrected/updated as time goes on. Any field that is open can have different details entered into them at a later time. For example- the date range could be incorrect due to an incorrectly keyed date, the number of units could have changed due to later communication, or the units could be spread over a weekly, monthly, yearly, etc. period of time that might have not been denoted when the auth was originally saved.</p><p>Starting from the point where a client has been searched and selected. 1. Click Select to the left of the authorization that needs to be edited.</p><p>2. This will open the popup window and allow the user to see all the details about the authorization. 3. Update any information that is now correct (in this example, the units will be decreased).</p><p>4. Click SAVE to update the corrected information. *Note- nothing else about the authorization will change and it will retain the same Insurance Auth Number.</p><p>*Please Note- Although the ACTIVE box is able to be unchecked, we urge providers to not make authorizations inactive. This is so that a record of authorizations can be retained. This also ensures that if notes are submitted that require units from an older authorization, those units will still be in place. The better option is to simply make sure the authorization has the correct end date in place. -Client Authorizations</p><p>Flex Units Used Throughout the documentation, the area labeled, “Flex Units Used” might have been noticed. That box will count from the total number of units based on the moment a note is submitted. For example- if an auth has 18 units and a note is submitted with 2 units, the Flex Units Used box will show “2”. Meaning there are 16 total units still available. If another note is submitted later that day with another 2 units, the box will show “4”. What this section is meant to do is have a real-time counter of units to help avoid a denial for “unauthorized units”. </p><p>*This detail can be seen by clicking SELECT to the right of any authorization. -Client Authorizations</p><p>Service Authorization Request (SAR) Adding/Submitting a SAR To submit a Service Authorization Request to an MCO that is synced with AlphaMCS, or to find a previously entered SAR, you can use the Client Authorization submodule. This section will review how to create a SAR. *Please Note: The Add New SAR button will only appear for clients that have an active MCO Insurance that is being synced and an active Authorization that is being synced with the MCO.</p><p>Starting from the point where a client has been searched and selected. 1. Select the SAR tab and click Add Client SAR.</p><p>2. Complete the required fields (indicated with an asterisk*) on the SAR Required tab.</p><p>3. Click SAVE. 4. Click on the “X” in the right-hand corner if you would like to exit the SAR entry screen and return to the client’s -Client Authorizations homepage. 5. This will complete the necessary SAR fields.</p><p>The remaining tabs, Diagnosis, Substance Abuse, Medical and Documentation are not required, but can be included when sending this information to the MCO to justify the services requested and will display records based on the information stored in the client record. </p><p>To add these additional details: 1. For the Diagnosis Tab. Select the “Include on SAR” checkbox option for the DXs that need to appear on the SAR.</p><p>2. Repeat step 1 for the other three sections if there is a need to include Substance Abuse, Medication, or additional Documentation. 3. Click the Save button when complete. 4. Click the Submit button to submit your SAR to the MCO. *Please note: Once a SAR has been submitted it can not be modified.</p><p>Checking the Status of a SAR -Client Authorizations</p><p>The SAR can be saved and finished at a later time or can be submitted. Once submitted, the MCO has fourteen (14) days to review the request. Once the SAR has been saved and/or submitted, the status can be checked within the Client Authorization submodule. To view the status of the SAR scroll to the far right of the SAR screen for this information. </p><p>Other than the examples in the screen shot above, the user might see: SAVED, SUBMITTED, or ADMINISTRATIVE DENIAL in the status field. A SAR with any level of denied status may be appealed by the provider following standard MCO appeal protocol. Denials may not be appealed electronically.</p><p>Expedited SARs There are occasions where a SAR might be of high priority. This is considered to be an Expedited SAR and is marked with the checkbox “Is Expedited”. A SAR marked as “Is Expedited” will be reviewed by your MCO within three (3) business days. Creating and viewing the status of this level of SAR is the same as with a regular SAR.</p>