How Does Therabill Automatically Choose an Authorization for an Insurance Claim?

Using Therabill's Authorization Watch, you can conveniently put insurance authorizations on your claim forms and set reminders to alert you when authorizations are expiring or expired. When you submit a claim to insurance and Authorization Watch is enabled, Therabill automatically will assign the session to the authorization that is expiring next. This provides a simple, hands-off method for handling authorizations.

How Authorization Watch Works

Every insurance claim you submit goes through Authorization Watch. This feature determines whether an authorization should go on the claim, and if so, which one. If Therabill determines that an authorization should go on the claim—and you’ve entered multiple authorizations for the patient—Therabill will default to the authorization that will expire first.

How does Therabill decide which authorization to use?

When you submit a claim to insurance, the session goes through an automated process to determine whether:

• an authorization should go on the claim
• an authorization is required (and which one to use)
• the session count on the authorization needs to be adjusted

During the initial screening process (illustrated by the chart at the top-left of this screen), if the system determines that an authorization is required and you have not indicated which authorization to use, the claim will go through a series of tests to determine which authorization to apply.

Initial Screening

The initial screening determines whether Therabill will select the authorization. Here are the questions that drive this decision process:

• Is Authorization Watch enabled for the patient? If not, then Therabill will bypass authorizations altogether.
• Was the session already assigned to an authorization? If so, then Therabill will use that authorization and will not decrease the number of sessions remaining on the authorization.
• Did you manually indicate which authorization to use? If so, then Therabill will use that authorization as long as it’s not expired. If the authorization is expired, then you will receive an authorization watch error.

Automatic Authorization Match

If, after going through the initial screening, Therabill determines that an authorization is required and that Therabill needs to determine which authorization to use, then Therabill will send the claim through the series of tests shown in the image below. These tests determine which authorization to use based on the parameters you set for the authorization.

The tests occur in the sequence shown in this image. The columns represent all of the possible parameters. Green shading indicates the parameters that must be met to pass each test. Starting with test I, Therabill will run the four tests in sequential order. If, at any point, the session passes the test for an authorization, Therabill will use that authorization. If multiple authorizations are possible, Therabill will order them in ascending order according to the expiration date and the number of sessions remaining. The system will then default to the authorization that will expire first.

My Authorizations transfer from WebPT. How does that fit into this process?

When you finalize a note in WebPT, Therabill automatically creates a session (i.e., a charge) in Therabill. When an authorization comes over from WebPT, Therabill automatically creates a new authorization (as long as an authorization with the same authorization code does not already exist). Therabill will then assign the session to that authorization. Thus, during the initial screening, Therabill will determine that an authorization was manually set for the session.The system will then default to that authorization.