Authorizations

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This topic describes how to add, edit, and delete Authorizations, which are the terms of service for Placements—including the type, duration, and frequency of service. Proper management of Authorizations is vital in ensuring that Providers correctly schedule and bill for services.

Add an Authorization

To add an Authorization, complete the following steps.

Step	Action
1	At the top right of the Authorization page (Member, Search, search for and select a Member, Authorization), click Add Authorization.
2	In the dialog that appears, fill out the following fields under Authorization. Add Authorization Dialog Authorization Number - (Required) The identifying number associated with the Authorization in HHAeXchange. Service Category - (Required) The Member’s Service Category: Home Health or Non-Home Health. Note that the selected Service Category affects which Service Codes are available. Service Type - (Required) The type of service that the Provider is authorized to provide (such as HHA, RN, HSK, PA, etc.). Provider - The Provider who receives the Authorization. Note that this field is locked unless the Member has already been placed with a Provider. Service Code - (Required) The Service Code associated with the Authorization. This code dictates the Rates the Provider can apply to a Visit. Service Code Type - Displays the type of service code to be used for the Visit: Daily, Hourly, or Visit type. While Daily bills on a service provided daily, hourly bills based on the number of hours of service. Visit type bills at a Visit level. From/To Dates - (Required) The date range of the Authorization. Program Code - Some Payers use their own Program Codes to identify Members using specific home healthcare programs, such as a self-directed program. Members can have multiple Authorizations with a different Program Code for each or the same Program Code for all Authorizations. Only appears when the Service Category Home Care is selected and when the field is assigned to the Payer by HHAeXchange. Budget Amount ($) - Some Members are assigned a budget dollar amount (rather than units) to determine the services provided. The Budget Amount ($) field is used for the total budget dollar amount. Only appears when the Service Category Home Care is selected and when the field is assigned to the Payer by HHAeXchange. Diagnosis Code(s) - If the Service Category is non-Home Health, free-text boxes appear containing the member’s Billing Diagnosis Codes. If the Service Category is Home Health, a panel appears within which users can search for and select up to 26 ICD-10 Codes, as well as designate an Admit and Primary Dx. Note: Payers can contact the HHAX Support Team to specify that a Provider should enter Billing Diagnosis Codes instead. Codes will then be transferred back to the Payer in the Claim file. Enabling Billing Diagnosis Code entry for a Provider disables it for a Payer.
3	Select an Authorization Type with which you will specify the number of hours to be allotted Daily, Weekly, Monthly, or for the Entire Period. Authorization Type Menu Authorization Types include: Daily - You specify the number of service hours permitted per day, as well as what time of day the Visit must be scheduled by selecting the Start Time. If service is always scheduled for the same time and duration, use the Master column to enter service details. Then, select Apply Master above each day to apply them. Weekly - You specify the number of service hours allowed per week. Monthly - You specify the number of service hours allowed per month. Entire Period - You specify the number of service hours allowed for the length of the Authorization. Additional authorization rules that apply to Weekly, Monthly, or Entire Period authorizations can be set up by a Payer to limit the authorization use by a Provider.
4	(Optional) If desired, attach a file to the authorization with the Upload File button. You can also add Notes (or Internal Notes, which are not visible to the Provider).
5	At bottom right, click Add Authorization to finish adding the Authorization.

Add Additional Authorizations for a Single Placement

To add additional Authorizations for a Placement, on the Member’s Provider Info page (Member, Search, search for and select a Member, Provider Info), click Add another authorization under an existing Authorization, as shown in the following image. In the panel that appears, complete the new Authorization.

You can add up to 52 Authorizations for a single Placement.

Partial image of the Authorization page with the Add Another Authorization link at lower left highlighted

Adding Another Authorization

Edit an Authorization

To edit an Authorization, complete the following steps.

Step	Action
1	On the Authorization page (Member, Search, search for and select a Member, Authorization), to the right of the Authorization to edit, in the Action column, click the ellipsis (...), and select Edit. Editing an Authorization
2	In the dialog that appears, make changes to the Authorization. Some fields are locked to prevent billing and scheduling issues. You can add, view, and delete Blackout Dates (dates not available for scheduled visits) for any existing authorization.
3	At bottom right, click Save to update the Authorization. A note is automatically created and saved to the Member’s Notes page. Note: HHAX strongly advises giving Providers advanced notice if an Authorization update drastically changes a Member’s scheduling requirements.

Step

Action

On the Authorization page (Member, Search, search for and select a Member, Authorization), to the right of the Authorization to edit, in the Action column, click the ellipsis (...), and select Edit.

Partial image of the Authorization page with the Actions menu (...) expanded and the Edit command circled

Editing an Authorization

In the dialog that appears, make changes to the Authorization. Some fields are locked to prevent billing and scheduling issues.

You can add, view, and delete Blackout Dates (dates not available for scheduled visits) for any existing authorization.

At bottom right, click Save to update the Authorization. A note is automatically created and saved to the Member’s Notes page.

Note: HHAX strongly advises giving Providers advanced notice if an Authorization update drastically changes a Member’s scheduling requirements.

Note: To sync and refresh an authorization that has been edited by the Provider, click the three dots to display a menu and select Sync and Refresh. Sync and Refresh updates the authorization within the HHAX system.

Delete an Authorization

To delete an Authorization, in the Action column, click the ellipsis (...) and select Delete. A note is automatically created and saved to the Notes page.

Note: Use the Delete function only when an Authorization is sent with an incorrect Service Type, Service Code, or Authorization Type. If an Authorization must be deleted, remove it as soon as possible. After a Provider uses any part of an Authorization, the Authorization cannot be deleted.