đĽď¸ For providers using the Oasys web app. Practice billing staff with the Billing permission use the same screen in Practice HQ (see Setting up practice billing).
This article explains how to record a client's prior authorizations from their insurance payer, how Oasys counts sessions against them, and how they're added to your insurance claims. It also covers the Prior Auth badge and what happens when an authorization expires or runs out of sessions.
In this article
1. Where to find prior authorizations
Prior authorizations are kept per client, in the client's billing settings. The tab only appears for clients whose billing type is Insurance.
In the Oasys web app: go to Billing â Client billing, open the client, then Settings â Prior authorizations.
In Practice HQ: go to Billing â Client billing, open the client, then Settings â Prior authorizations. For a client seen by more than one provider, the authorizations sit under Settings â Insurance info.
The tab lists each authorization with:
Authorization: its status, the authorization number, the payer and, if it applies, an EAP badge.
CPT: the CPT codes it covers.
Validity: the effective and expiry dates.
Sessions: sessions used out of sessions authorized (for example, 4 / 12 used).
Active authorizations are listed first, then future, expired and exhausted ones.
2. Adding a prior authorization
Open the client's Prior authorizations tab.
Click Add prior authorization.
Fill in the fields below.
Click Add.
The fields
Payer (required): the insurance company that issued the authorization. You choose from your accepted payers. If the list says No accepted payers configured, add the payer first (see Setting up insurance billing).
Authorization number (required): the number the payer gave you. If you type a leading #, Oasys removes it.
CPT codes (required): the services the authorization covers. Search by code or description and pick at least one.
Effective date (required): the first date of service the authorization covers. It starts as today's date.
Expiry date (required): the last date of service it covers. It must be on or after the effective date.
Sessions authorized (required): how many sessions the payer approved, as a whole number of 1 or more.
Sessions already used: sessions used before you started tracking this authorization in Oasys, for example sessions billed through another system. Leave it at 0 if there were none. It can't be more than the sessions authorized.
EAP authorization: tick this if the authorization is from an Employee Assistance Program. If your practice uses claim rules, a rule can match EAP authorizations (see Claim rules).
You can't save two authorizations with the same number for the same client and payer.
If the dates and CPT codes overlap another authorization for the same payer, Oasys still saves it and shows Overlapping prior authorization. When two authorizations overlap, the one that expires first is used first.
3. How sessions are counted
A session is counted against an authorization when its insurance claim is submitted to the payer. Drafts don't count.
Sessions used is the Sessions already used number you entered plus every session submitted on a claim with this authorization.
Each session counts once, even if its claim has several service lines or units.
Claims that are Submitted, Received, Accepted, Paid, Partially paid, Patient responsibility or Needs investigation count.
A claim that's Rejected, Denied, Voided or Submission failed gives its session back to the authorization.
Correcting and resubmitting a claim for the same session doesn't use a second session.
Authorization statuses
Active: today is within the dates and sessions are left.
Future: the effective date hasn't arrived yet.
Exhausted: every authorized session has been used.
Expired: the expiry date has passed. An expired authorization shows Expired even if sessions were left.
Statuses update on their own. If a claim's session is given back (for example, the claim is voided), an Exhausted authorization goes back to Active.
4. Editing and deleting a prior authorization
Use the three-dot menu on an authorization's row.
Editing
Choose Edit. The Edit prior authorization dialog opens.
Change the fields you need.
Click Save changes.
Some changes are blocked so the authorization still matches the claims already sent with it:
The Payer can't be changed after the authorization is created.
You can't remove a CPT code that a submitted claim has used.
You can't move the dates so that a submitted claim's date of service falls outside them.
You can't set Sessions authorized below the sessions already used.
Deleting
Choose Delete and confirm. This permanently deletes the authorization.
You can only delete an authorization that no claim uses, including draft claims.
If a claim uses it, Oasys tells you how many claims are recorded against it.
If the payer is wrong on an unused authorization, delete it and add it again with the right payer.
5. Prior authorizations on insurance claims
Oasys adds an authorization to a claim when one applies. An authorization applies when it's for the claim's payer, covers the CPT code, covers the date of service, and has sessions left.
In the claim wizard
When you bill a session from Bill sessions, the claim details show Authorization for CPT followed by the code.
Oasys picks the applicable authorization that expires first.
Each choice shows the authorization number, how many of its sessions are left, and its expiry date.
Choose a different authorization from the list, or choose No prior authorization to send the claim without one.
If none applies, you'll see No applicable prior authorization for CPT and the code.
Each additional service line has its own Authorization for CPT list. It uses the claim's authorization (Use claim authorization) unless you choose a separate one.
If you change the CPT code, Oasys checks the authorization again. You'll see Prior Authorization Retained if it still covers the code, or Prior authorization removed if it doesn't.
Claims Oasys creates for you
When claims are created without the wizard, such as by auto-billing or when you bill several sessions at once, Oasys attaches the applicable authorization that expires first and covers every line on the claim. When several sessions compete for the last sessions on an authorization, the earliest date of service gets it. If no authorization applies, the claim is created without one.
What goes on the claim
The authorization number is sent to the payer as the claim's prior authorization number (Box 23 on the CMS-1500).
Open the claim in Manage claims to see it as Prior Auth # on the Overview tab.
Oasys checks the authorization again when the claim is submitted. If it was deleted, has expired for that date of service or has no sessions left, the submission stops with a message explaining why.
For tracking claims after submission, see Billing insurance claims.
6. The Prior Auth badge and alerts
Oasys flags insurance clients who have an active authorization.
The Prior Auth badge
A Prior Auth badge shows next to the client in Billing â Client billing, in both the Oasys web app and Practice HQ.
Green: the client has an active prior authorization on file.
Amber, with a warning icon: an active authorization needs attention. It expires in less than 60 days, or has 3 or fewer sessions left.
No badge: the client has no active authorization (none on file, or all are future, expired or exhausted).
The alert on the client's chart
When an active authorization needs attention, the client's chart shows Prior authorization needs attention, with the authorization number and the reason (for example, "expires in 21 days and 2 sessions left").
Click Review to open the client's Prior authorizations tab without leaving the chart.
Click the X to dismiss the alert. It stays dismissed for that authorization in this browser, and comes back for a different authorization.
7. When an authorization runs out or expires
When an authorization is Exhausted or Expired:
It isn't offered in the claim wizard or attached to claims.
Oasys doesn't stop you billing the client. Their claims go out without a prior authorization, unless another authorization applies.
The Prior Auth badge disappears if the client has no other active authorization.
To keep billing under an authorization:
If the payer approves more sessions on the same authorization, edit it and raise Sessions authorized (or move the Expiry date).
If the payer issues a separate authorization, add it as another prior authorization. Older ones stay in the list for your records.
đĄ Tip: Watch for the amber Prior Auth badge. It appears while the authorization is still active, giving you time to request more sessions before it runs out.
Frequently asked questions
Why don't I see the Prior authorizations tab?
The tab only shows for clients whose billing type is Insurance. Change the billing type in Billing â Client billing (see Choosing a client's billing type).
Why isn't my payer in the Payer list?
The list shows your accepted payers. Add the payer to your accepted payers first, then add the authorization.
Does a draft claim use up a session?
No. A session is counted only when the claim is submitted. A rejected, denied or voided claim gives the session back.
Why wasn't an authorization added to my claim?
It must be for the claim's payer, cover the CPT code (and every additional line's code), cover the date of service and have sessions left. Check the authorization's dates, CPT codes and status on the client's Prior authorizations tab.
Why can't I delete an authorization?
A claim uses it. Authorizations used by any claim, including drafts, can't be deleted.
I was already using some sessions before Oasys. How do I record them?
Enter them in Sessions already used when you add the authorization. They count toward the total along with claims sent from Oasys.