Pre-Authorizations are used to confirm what percentage of procedure code fees the carrier will cover for the patient. With a pre-authorization, you submit the treatment codes to the carrier, inquire and confirm what they will pay, instead of completing the treatment and then crossing your fingers and hoping they pay.
The Pre-Authorization report is used to track the status of the pre-authorization that has been created. It allows a user to confirm that pre-auth has indeed been sent, monitor the status, and schedule patients for whom pre-auths have been approved. This report shows real-time data and is available in two views: Summary and Detail View.
Competitor Reports
- Pre-authorizations to Process, Preauthorization Aging Report (Dentrix)
- Outstanding Claims Report (Eaglesoft)
- Outstanding Insurance Claims Report-Filter by Pre-Auth (Open Dental)
Use Cases
To track pre-authorizations to ensure treatment is approved to avoid any chance of rejection of claims.
Let's get started!
Navigate to the System Menu > select Operational Reports under Insights.
Click the + icon on the left or the Generate Report button on the right for the chosen report.
Explore below to learn more about the desired views, filter criteria, and results.
The Summary view shows the total number of pre-auths created by their current statuses and total estimated fees for the created pre-auths grouped either by a treatment provider or treatment location.
Let's explore the filters:
| No | Filters | Description |
|---|---|---|
| 1 | Group By* | This view of the report can be grouped by treatment provider or by treatment location. |
| 2 | Date Range (Max 1 year)* |
The pre-authorization report is dated by the created date. *By default, the date range will be Today. |
| 3 | Location* |
Select the location(s) to focus the report on the pre-authorizations in the selected location(s). *By default, the location will be the user’s default location. |
| 4 | Provider | Select the provider(s) to focus the report on pre-authorizations with the selected provider(s) as treatment providers. |
| 5 | Auth Status | Select the Auth status(es) to focus the report on. |
| 6 | Auth Flag | Select the Auth Flag(s) to focus the report on. |
Once you have selected the desired filters, click on the Generate button to generate your on-screen report or Download Report As button to download your report.
Generation/Download Criteria
- Due to data volume, reports with more than 5 Treatment Locations and a date range of 6 months will not be generated on-screen.
- Reports meeting these criteria will be accessible in the Scheduled Downloads section.
Result - Summary View
Now, let's take a look at the results of the Pre-Authorization Report (Summary View).
- Auth. Status: The current status of the pre-authorizations, whether they are in Draft status, Completed, Rejected, and so on.
- Not Scheduled-Count: The number of authorizations created for codes that are not scheduled.
- Not Scheduled-Est. Fee: The total estimated fees for all authorizations with no scheduled procedures included.
- Scheduled-Count: The number of authorizations with at least one scheduled procedure code in this status.
- Scheduled-Est. Fee: The total estimated fees for all authorizations with at least one scheduled procedure included.
- Grand Total-Count: The grand total number of procedure codes included on authorizations in this status.
- Grand Total-Est. Fee: The grand total of estimated fees of all procedure codes included on authorizations in this status.
Click on the blue-colored entries to view more information on the corresponding entries.
The detailed view gives the information regarding each Auth form, including details like Created Date, Auth ID, Patient Name, Est. Fee, Est. Ins., Est. Pat., Auth Status, Sched. Status, etc.
| No | Filters | Description |
|---|---|---|
| 1 | Date Range* |
The pre-authorization report is dated by the created date. *By default, the date range will be Today. |
| 2 | Location* |
Select location(s) to focus the report on the pre-authorizations in the selected location(s). *By default, the location will be the user’s default location. |
| 3 | Provider | Select the provider(s) to focus the report on pre-authorizations with the selected provider(s) as treatment providers. |
| 4 | Auth Status | Select the Auth status(es) to focus the report on. |
| 5 | Auth Flag | Select the Auth flag(s) to focus the report on. |
| 6 | Sched. Status* | Choose to focus the report on the scheduled status of the treatment and on the authorization. |
| 7 | Columns* |
Choose the columns you wish to see in this report. *By default, the 15 most relevant columns are selected. |
Once you have selected the desired filters, click on the Generate button to generate your on-screen report or Download Report As button to download your report.
Generation/Download Criteria
- Due to data volume, reports with more than 5 Treatment Locations and a date range greater than 6 months cannot be generated on-screen.
- Reports meeting these criteria will be accessible in the Scheduled Downloads section.
Result - Detail View
Now, let's take a look at the results of the Pre-Authorization Report (Detail View).
- Created Date: The date of creation of the pre-authorization.
- Submitted Date: The date on which the authorization was marked as submitted in the system.
- Auth ID: The system-assigned number used to identify the unique authorization that has been generated.
- Auth No: The number provided by the insurance carrier used to identify the specific pre-authorization estimate.
- Patient Name: The name of the patient.
- Patient ID: The system-assigned number used to identify the patient and their records. On clicking on the Patient ID, the user is taken to the authorizations page of the patient's profile.
- D.O.B: The patient's date of birth as specified in their patient profile.
- Contact No: The phone number of the patient, provided for convenient access for your workflow needs.
- Subscriber Name: The name of the subscriber listed on the patient's insurance plan.
- Subscriber ID/SSN: The subscriber's ID or social security number, used to identify the subscriber and their coverage.
- UCR Fee: The total UCR fees calculated from the procedure codes on the authorization, based on the office's standard fees.
- Est. Fee: The estimated total receivable for the procedure codes on the preauthorization.
- Est. Ins: The estimated insurance receivable for the treatments included in the pre-authorization.
- Est. Pat: The estimated patient receivable for the treatments included in the pre-authorization.
- Auth Status: The current status of the pre-authorizations, indicating whether it is in Draft status, Completed, Rejected, etc.
- Auth Flag: The current flag tagged against the pre-authorizations.
- Actual Ins.: The estimated insurance payable as provided by the insurance carrier in the authorization response.
- Actual Pat.: The estimated patient payable as provided by the insurance carrier in the authorization response.
- Sched. Status: The status of the treatment on the authorization, indicating whether it has been scheduled or not.
- Mode: The mode of the pre-authorization, indicating whether it is submitted electronically or by paper.
- Location: The location in which the authorization is generated, corresponding to the treatment location of the codes.
- Provider: The treatment provider associated with the procedures included in the authorization.
- Provider TIN/NPI: The treatment provider's unique identifier number used to distinguish the eligible clinician.
- Carrier Name: The name of the insurance carrier associated with the pre-authorization.
- Carrier ID: The carrier identifier number used to route an electronic claim to the correct destination (i.e., insurance carrier).
- Carrier Phone No: The phone number used to reach the insurance carrier (as entered in insurance details in your practice settings).
- Plan Name: The name of the patient's insurance plan pertaining to the treatment and pre-authorization request.
If users in your practice cannot use this report, please ensure that the relevant permissions are enabled.
To enable Permissions for the Pre-Authorization Report:
- Navigate to the System Menu > Practice Settings > Administration > Profiles.
- Click Manage Permissions for the intended profile.
- Select Insights.
- Select the Generate Pre-Authorization Report option under Operational Reports to enable the permission.
- Click Save.
- On the Confirm Action modal that appears, click Yes to proceed.
- A toast notification appears on the top right stating, 'Profile updated successfully'.
Practices can use this comprehensive guide to efficiently generate reports, explore various use cases, and apply the necessary filter criteria to generate the desired report. Following this guide will help you create reports quickly, understand the different views available, and customize reports to meet specific needs.
Click here to explore the complete list of permissions and their descriptions.