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            Add Care Request Details to the Authorization Request

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            Add Care Request Details to the Authorization Request

            Authorizations require that you add details about the requested service. The details you enter depend on whether the care request is new or existing, and inpatient or outpatient.

            Required Editions

            Available in: Lightning Experience

            Available in: Enterprise and Unlimited Editions with Health Cloud
            User Permissions Needed
            To add care request details: Health Cloud Utilization Management, OmniStudio User, and RuleEngine Runtime permission sets
            1. From App Launcher, go to the Utilization Management for Payers app, and do the following:
              1. Select an authorization request type.
              2. Run an eligibility check for your care request or link a concurrent review to an existing request, depending on your request type.
            2. On the Add Request Details window, specify whether the request is an initial request or extension request.
            3. For Initial Requests for inpatient procedures:
              1. Select the date that you received the care request.
              2. Select the type of admission, for example, emergency or elective.
              3. Select the level of service rendered.
              4. Enter the scheduled admission date for the patient.
              5. Enter the requested length of stay for the patient.
              6. Select the level of care requested for the patient.
              7. Select the type of facility bed for the patient.
            4. For Initial Requests for outpatient procedures:
              1. Select the date that you received the care request.
              2. Select the level of service rendered.
              3. Select the service date.
            5. For Extension Requests for inpatient procedures:
              1. Select the level of service rendered.
              2. Enter the date that the payer received the extension request.
              3. Enter the ID of the previous care request in the Previous Authorization Request ID field.
            6. For Extension Requests for outpatient procedures:
              1. Select the date that you received the care request.
              2. Select the level of service rendered.
              3. Enter the ID of the previous care request in the Previous Authorization Request ID field.
            7. For Concurrent Review Requests linked to an existing inpatient request:
              1. Select the level of service rendered.
              2. Enter the scheduled admission date for the patient.
              3. Enter the requested length of stay for the patient.
              4. Select the level of care requested for the patient.
              5. Select the type of facility bed for the patient.
            8. For Concurrent Review Requests linked to an existing outpatient request:
              1. Select the level of service rendered.
              2. Select the service date.
            9. Under Code Details, view and add the details of the diagnosis and service codes.
              1. Search for a diagnosis code and click Add.
              2. Enter the start date and end date for each service code.
              3. To provide more information about the service code, add a modifier code.
              4. Enter a value for quantity and quantity type. For example, 2 visits.
              5. For concurrent review requests linked to an existing request, select the service codes to carry over from the linked request. You can’t add or update service codes.
            10. Click Next to go to the next screen in the Authorization process.
             
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