There are various types of authorizations used by the system to try and make sure providers get paid correctly for the work that they do. All service plans are also authorizations. If a client does not have a valid, current authorization in place then the system severely limits what services can be provided to the client. The goal is to have a string of continuous authorizations for a client with no gaps.
A Preauth Request is the initial authorization to provide services for the client. Normally it is a short term (3 month) authorization intended to pay for an initial assessment, initial service plan, and a few other services until the initial service plan is completed. However, certain payer sources will allow a 12 month duration for a Preauth Request in order to facilitate avoiding the use of a service plan all together. Some payers restrict a client to one Preauth Request per calendar year.
A Moderate Complexity Service Plan is an initial service plan, lasts for 6 months, and is normally completed before a Preauth Request expires. Some payers restrict a client to two service plans per calendar year.
Effective dates for some payer sources can only be backdated 7 days.
A
Low Complexity Service Plan is an extension service plan, lasts for 6 months, and normally directly follows either an initial or extension service plan. These are meant to be completed up to 14 days before or 7 days
after the current initial or extension plan expires. Since expires dates in ChartCaddy are not inclusive, when possible the effective date of an extension plan should be the same as the expires date of the previous plan. When possible the Start and Stop date of an extension should be before the effective date or else the plan is "paying for itself", which some payer sources frown upon. Some payers restrict a client to two service plans per calendar year.
Effective dates for some payer sources can only be backdated 7 days.
A Review Request functions like a Preauth Request except it is used only when an extension plan is not completed in time. Although Review Requests are available for all payer sources, they are only really useful for OKHCA payer sources that enforce the 7 day backdating. After
that time period you must do a review request in order to do a new extension service
plan, but the Review Request can only be be backdated up to 7 days as well. There is very little money granted with this authorization so you should limit what services you perform with this authorization other than the extension service plan.
Plans and services with names ending in "Preauth" are paid for by the Preauth Request or Review Request authorizations. Normally the initial service plan is a Preauth service but the extension service plan is not.
Plans and services with names ending in "Auth" bypass usage checks, run a much higher risk of being denied, and therefore should only be used as a last resort. These services only exist for certain rare circumstances and should be disabled for most organizations.
Plans and services with names ending in "Supervised" only appear for OKHCA payer sources that pay a different rate for service performed by providers that are under supervision for their license.
Plans and services ending in Bachelor's, Master's, or JOLTS pay a different rates and (except for Case Management) only appear for JOLTS payer sources.
NOTE: If you ever have trouble finding a specific plan please don't hesitate to call or email us.