Pre-Authorization

When preauths are required by insurance, use the following resources

• View and Submit Pre-Authorizations of a Single Patient

• Manage All Preauthorizations

• Manage Preauth ERA’s

Entering a Pre-Authorization Response Overview

Pre-Authorizations (Pre-Auths) are used to obtain an estimated coverage decision from an insurance carrier prior to treatment being completed. Entering the carrier’s response accurately in CareStack helps ensure the practice has updated insurance estimates, proper documentation, and clear communication regarding patient financial responsibility. Proper Pre-Auth management also helps reduce claim denials, unexpected patient balances, and scheduling delays.

Step 1
Locate the Pre-Authorization in the Patient’s Chart

• Navigate to:

Billing → Pre-Authorizations

• Use filters as needed:

  • Pre-Auth ID

  • Tx.Provider

  • Location

  • Carrier

  • Plan

  • Mode

  • Insurance Type

  • Submitted Date

  • Pre Auth Flag

  • Status

• Select the Pre-Authorization to open it.

Please Note:

When handling multiple pre-authorization entry, you can post these by navigating to
Menu → Billing: Pre-authorizations → Pending Response tab

Step 2
Enter Insurance Response Details

• Navigate to:

Pre-Authorization Response

• Enter Pre-Auth. Number * 

• Enter Expiry Date *
   

• For each procedure line item: 

  • Update Status:

    • Covered 

    • Not Coved

  • Enter Act. Ins. Est (Actual Insurance Estimate) indicated on Pre-Auth

  • Enter Act. Pat. Est (Actual Patient Estimate) indicated on Pre- Auth

  • Notes:

    • Enter any notes applicable to Pre- Auth

• Click Save & Complete.

             *  Indicates a Mandatory field

• A notification will appear on the top right stating “Pre-Authorization Completed Successfully”

• Pre-Authorization status will now be set to completed

• Codes in your treatment plan will now reflect Pre-Auth Complete with updated estimate information

• Once the codes are completed and claim is created, your pre-authorization number will auto-populate in box 2 on the claim form

BEST PRACTICES

1. Always create pre-auths from Treatment Planner when possible

2. Resolve all remarks before submission

3. Complete all required fields to avoid delays

4. Attach supporting documentation upfront

5. Use flags and comments for tracking and communication Recommended Pre Authorization Claim Flags

6. Monitor Ready to Send status daily

7. Add clear remarks when editing for audit history

8. Use your internal workflow to ensure patients are scheduled for treatment prior “expiry date”