Bookings to Discharge: Hospital Patient Administration

A Patient will get an authorization for the permission from their Medical aid that a certain Procedure or Operation can be done on the Patient

When you need to do an Authorisation you have to do it the old trusted way, spend time on the telephone with the relevant Medical Aid. This will supply you with the required authorisation number.

You will need to provide them with at least the following patient details in order to get the authorisation:

• Full names and Surname of the Patient and Main Member
  
• The ID number of the Patient and Main Member
  
• Medical aid number
  
• Type of procedure, CPT4 Codes
  
• Diagnose of the Patient, ICD10 codes
• Date of the procedure
  

The more information you have on hand the better. This is also the time that you try to ensure that there is enough credit available on the plan to do the required procedure. 
Ask, Confirm and ask again.

On GoodX the Authorization details can be added on the Case, this information will be sent to the medical aid when the Case is EDI. Without Authorization, the Medical aid will not pay the claim and reject the claim.

Add the Authorization on the Case

Authorisation details include:

1. Authorisation Code (The proof that the Procedure was approved and must be included in the claim)
   
2. Date From (From when the Auth is valid)
3. Date To (Until when the Auth is valid, how long the patient can stay in the Hospital)
4. Authorisation Amount (The Amount that the Medical aid approved for the Procedure)
   
5. Authorisation Contact (The person who gave the Auth, and for any further queries in connection of the Auth)
6. Authorisation Date (When was the Auth received)

This information is captured on the Case in the Authorisation tab once the case is opened. 

• Open the Case from the Case Management screen.
• Double click on the Case to open the Case Information screen.
• Click on the Authorization tab.

• Complete all the fields n the right-hand side and click on Add, 

• The Auth will create a line in the left with all the information that was completed

Edit the Authorization

The Authorization can also be edit after the Auth was created on the Case:

• Open the Case from the Case Management screen.
• Double click on the Case to open the Case Information screen.
• Click on the Authorization tab.
• Click on the line of the Auth.
• Change the details on the right-hand side and click on Update.

Deleting the Authorization:

• The Auth can also be deleted by clicking on the line and click on Delete.

Adding more than one Authorization on the Same Case:

• There can be more than one Auth on a Case. This can be done to click on the Add button after completing the information in the correct fields.

Save the details:

• Remember to Save the Case after the Auth was Added or Edited to be Saved on the Case.

Information on the Authorization tab screen:

• Recalc - When the Auth is edited the Recalc button can be used to recalculate the information on this screen.
• Total Auth Amount - The amount of the Total Auth that was received on the Patient for this Case. This will add together all the Auths on this Case if there is Multiple Auths.
• Total Auth Days - The days will be calculated from the Date from until the Date To, both dates will be included in the Calculation.
• Case Amount To Date - The amount on the Case that was invoiced as the billing on the case is done.
• L.O.S. To Date - Lenght of Stay (L.O.S.) is calculated from the admission date (When the patient was admitted) until the computer date if the Patient is not yet discharged, or if the Patient is Discharged the calculation will include the Discharged date on the Case.

The First Colour bar indicates the Case Amount against the Auth amount:

• Green - The Auth amount is still larger than the billed amount on the Case
• Yellow / Orange - The billed amount is getting near the Auth Amount
• Red - The billed amount on the case is more than the Auth amount. The Medical aid must be notified and an extra Auth can be requested.

The Second Colour bar indicates the L.O.S. against the Total Auth Days:

• Green - The Auth days is still more than the days the Patient is n the hospital
• Yellow / Orange - The days the patient is n the hospital is getting near the Days Auth that was received
• Red - The L.O.S on the case is more than the Total Auth days that was received. The Medical aid must be notified and an extra Auth can be requested.