Authorizations User Guide

Authorizations Overview

Insurers, Managed Care Organizations (MCOs), and other Payers may require individual authorizations before covering some procedures, services, or treatment types. Intensive or long-term outpatient therapies, for example, or inpatient admission to a substance use treatment facility, typically require authorization (also called pre-approval). Authorizations are submitted by health care professionals, approved or denied by the Payer, and, as needed, managed through various stages such as additional research, resubmission, or an appeals process until the services are paid (partially or in full) or denied. At the billing stage, SmartCare can apply the amount authorized to the amount billed and issue an invoice for the remaining amount. This user guide has two purposes: to document the [**Service Request and Review/Approval**](https://scribehow.com/shared/Authorizations_User_Guide__xd4NktVpRySJ1GmxwiXVtg#023b193c) process and [Authorizations](https://scribehow.com/shared/Authorizations_User_Guide__xd4NktVpRySJ1GmxwiXVtg#c5ddcc5a) process.

Applicable Release

The functionality in this User Guide is supported in: - SC.CORE.6.0_1 and later. Service Request and Review/Approval Process is supported in: - SC.CORE.6.0_1.15 and later.

Service Request and Review/Approval Process

Through the service request and review/approval process, the signed in user can request services, assign for review, and automatically create authorization records on successful approvals. Based on the logged in users permissions, the logged in user will either view Service Requests and Review/Approve through the Service Request List screen (Requestors), or through the Service Request-Review/Approval List screen (Approvers).

View Service Request-Review/Approval List

**Scenario: Logged in User is an Approver** Note: If the logged in user accessing the list page is an Approver, the list page will display as **Service Request-Review/Approval List**. This is controlled by Staff Permission (Screens>Service Request-Review/Approval List). The Approver can see all records in the list page. Approvers will also have access to the Reviewer screen, **Service Request List**. If **Clinical Data Access Grouping (CDAG)** is enabled in the environment, the Approver will only see records that are assigned to them. The same records will also be visible to their Supervisor(s). Said another way, any request assigned to an Approver are the only ones displayed to them and their Supervisor(s) when CDAG is enabled.

1

From the Client Search, navigate to **Service Request-Review/Approval List (Client)**.

The **Service Request-Review/Approval List** page opens. Refer to Service Request-Review/Approval List Page Field Definitions for information about each field.

[Why Can't I Access This Screen?](https://streamlinehealthcare.zendesk.com/hc/en-us/articles/17496625645460-Why-Can-t-I-Access-This-Screen)

View Service Request List Page

**Scenario: Logged in User is a Requestor** Note: If the logged in user accessing this list page is a Requestor (but not an Approver), the list page will show as **Service Request List**. This is controlled by Staff Permission (Screens>Service Request-Review/Approval List).The Requestor can see all records in the list page. If **Clinical Data Access Grouping (CDAG)** is enabled in the environment, the Requestor will only see records that they created. The same records will also be visible to their Supervisor. Said another way, any request created by a Requestor are the only ones displayed to them and their Supervisor(s) when CDAG is enabled.

2

From the Client Search, navigate to the **Service Request List (Client)**.

The **Service Request List** page opens. Refer to Service Request List Page Field Definitions for information about each field.

[Why Can't I Access This Screen? ](https://streamlinehealthcare.zendesk.com/hc/en-us/articles/17496625645460-Why-Can-t-I-Access-This-Screen)

**Service Requests Assigned to Workgroups** Note: If **Clinical Data Access Grouping (CDAG)** is enabled in the environment, the Approver will only see Service Requests assigned to Workgroups associated to the CDAG profile that the Approver staff is logged in under.

Requestor Requests Service and Submits for Approval/Review

3

**Scenario: Logged in user is a Requestor only.** From the Client Search, navigate to **Service Request List (Client)** screen.

The **Service Request List** screen opens. Refer to Service Request List Field Definitions for information about each field.