An insurance authorization records a payer's approval for a patient's care: the dates it covers, how much care is approved, and the authorization number that goes on claims. You add authorizations from the patient's edit page. Ambiki then counts what has been used, warns you when an authorization is running low or about to expire, and adds the number to that payer's claims.
At a Glance
Add authorizations on the patient's edit page, under Insurance authorizations.
Track each authorization by visits, units, or minutes.
Leave Disciplines or Billing code blank to cover all of them.
Usage is counted from signed treatment reports within the authorization dates.
The start date and number lock once the status is no longer Pending.
Requirements
For adding authorizations to work, the following must be in place:
Your practice is on the Professional plan.
You have permission to edit the patient's profile.
The patient has the payer saved as a payment method, so you can select it under Payers.
How Do I Add an Authorization?
Step 1: Open the Patient's Edit Page
Open the patient's profile and click Edit.
Edit patient profile
Step 1a: Edit the Authorization on the Patient Profile
As an alternative way to access the authorization page to edit, you can also start from the patient's Payments tab: click Authorizations on the left, then Edit.
Edit Authorization
Step 2: Open Insurance Authorizations
On the edit page, click Insurance authorizations in the list of tabs on the left.
Insurance authorizations page
Step 3: Add an Authorization
Click Add authorization. A blank set of fields appears below any authorizations the patient already has.
Add authorization
Step 4: Fill In the Details
Enter the Start date and Status, which are required, then fill in the rest of the fields that apply. Each field is explained in the next section.
Fill in authorization fields
Step 5: Save the Patient
Click Save patient at the bottom of the page. The authorization is not saved until you do.
Save patient
The authorization now appears on the patient's profile, under Payments and then Authorizations.
Authorizations on the patient profile
What Do the Authorization Fields Mean?
Start date: the first day the authorization covers. Required.
End date: the last day the authorization covers. Leave it blank when the authorization has no end date.
Status: Pending, Approved, Denied, Not Required, or End. Required.
Status note: a note for your team, such as what the payer is still waiting for.
Track by: choose Visits, Units, or Minutes to match how the payer approved care. The field below it changes to Maximum visits, Maximum units, or Maximum minutes. Enter the approved amount as a whole number. An Approved authorization needs a maximum to count as valid.
Number: the authorization number from the payer. Ambiki adds it to that payer's claims.
Number not needed: check this when the payer does not need a number on claims. Ambiki then sends no authorization number.
Disciplines: the disciplines the authorization covers. Leave it blank to cover all disciplines.
Billing code: the billing codes the authorization covers. Leave it blank to cover all codes.
Payers: the patient's payment method, or methods, that the authorization belongs to. Select the payer so the number goes on that payer's claims.
Exclude from all expiring authorization dashboards and alerts: check this to stop Ambiki from flagging the authorization when it runs low or nears its end date.
Remove authorization: removes the authorization when you save the patient.
What Can I Change After an Authorization Is Approved?
While an authorization is Pending, every field can be changed. Once it is saved with another status, some fields lock.
Start date and Number: locked.
Status: you can keep the current status or change it to End. An ended authorization cannot be reopened.
Track by and the maximum: can still be changed while the status is Approved, because payers often confirm the approved amount later. They lock for the other statuses.
End date, Status note, Number not needed, Disciplines, Billing code, Payers, and the exclude checkbox: can always be changed.
How Does Ambiki Count What Is Used?
Ambiki counts usage from the patient's signed treatment reports. A report counts when its date of service falls within the authorization dates and it matches the disciplines, billing codes, and payers you selected. Anything you left blank matches everything.
Visits: each matching treatment report counts as one visit.
Units: the units on each matching service are added together.
Minutes: the minutes on each matching service are added together.
The patient's profile shows the result as Used / Total and Remaining. Ambiki does not stop you from signing a note when the maximum is reached, so check the remaining amount before scheduling more care.
Where Can I See Authorizations?
On the patient's profile: click Payments, then Authorizations. Valid authorizations are highlighted in green. An authorization is valid when its status is Approved or Not Required, today falls within its dates, and it has not reached its maximum. Click View to open one.
In the Patient Authorizations list: open Record centers from your organization menu and click the Patient Authorizations icon to search and filter every authorization.
Patient authorizaitons
On your home dashboard: the Authorizations needing attention card lists authorizations that are close to their end date or running low.
When scheduling: if the patient's payer is set to require authorizations, Ambiki warns you when the patient has no valid authorization, when the authorization ends before the event does, when there are not enough visits left, or when units or minutes are running low. Click Continue to save the event anyway, or Cancel to close the event form.
When billing a visit: for authorizations tracked by units or minutes, Ambiki shows a note when few or none are left, or when the amount you enter is more than what is left.
An authorization is not flagged when a newer pending or approved authorization is already in place for the same payers, billing codes, and disciplines, or when you checked the exclude box.
Q&A
Q: Why is a payer missing from the Payers list?
A: The list shows the payment methods saved on the patient, each with its dates. Add the payer on the Payment methods tab, click Save patient, then return to Insurance authorizations and select it.
Q: Why can I not change the start date or the number?
A: Both lock once the authorization is saved with a status other than Pending. To correct one, click Remove authorization, add a new authorization with the right details, and save the patient.
Q: Why does an approved authorization show as not valid?
A: An Approved authorization is valid only when today falls within its dates and some of its maximum is left. Check that the dates are current and that a maximum is entered and has not been used up.
Q: Why do I see a message about disciplines and billing codes when I save?
A: The message appears when a discipline you selected is not billed under any of the billing codes you selected. Remove that discipline, or add a billing code it is billed under, then save again.
Q: Why is the authorization number missing from a claim?
A: Ambiki adds the number from an authorization that has the claim's payer selected under Payers, has a status of Approved or End, and covers the date of service. Check those three things, and check that Number not needed is not selected.
Heather Roulston
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