Additional Rules

Additional authorization rules can be set up by a Payer to limit the authorization use by a Provider. The Payer can set up to seven additional rules for a qualifying authorization.

Additional Payer Authorization Rules apply to weekly, monthly, or entire period authorizations.

Additional Rules are displayed on the Authorization tab.

Partial image of the Authorization page showing Additional Rules highlighted at lower left

Additional Rules in Authorization window

Add an Additional Rule

Additional Payer Authorization Rules are added on the Authorization tab (Member > Search Member > Authorization).

Users can add an Additional Rule as described in the following table.

Step	Action
1	After you search for and select the Member, click Authorization at left. Clicking Authorization
2	For any authorization with an Authorization Type of Weekly, Monthly, or Entire Period, click Edit at right. Clicking Edit
3	Select the Additional Rules box, set criteria for the additional rule, and then click Save. Note: You can click the Add Row icon if you want to add more than one additional rule. Adding an Additional Payer Authorization Rule

Step

Action

After you search for and select the Member, click Authorization at left.

Image of the tabs available at left when a Patient search is performed and a Patient selected. Authorization is highlighted.

Clicking Authorization

For any authorization with an Authorization Type of Weekly, Monthly, or Entire Period, click Edit at right.

Partial image of the Authorization tab showing the Actions menu expanded at right and the Edit command highlighted

Clicking Edit

Select the Additional Rules box, set criteria for the additional rule, and then click Save.

Note: You can click the Add Row icon Add Row (+) icon if you want to add more than one additional rule.

Partial image of the Authorization tab with the Additional Rules checkbox selected and highlighted. Sample data is displayed in the Additional Rules fields.

Adding an Additional Payer Authorization Rule