Step 3-Initiate Prior Authorization

TABLE OF CONTENTS

• Patient
• Patient Information
  • Example View
• Search for JCODE/CPT code
  • Example View
• Patient Insurance Information
  • Example View
• Guide me to Step 4-Select Authorization Form

Patient

• Enter patient first and last name
• Enter patient date of birth

Patient demographics will be entered in one of two ways:
--Entered Manually
--Pre-populated and selected.

If the patient you are looking for does not populate, the patient will need to be entered manually. 

Limitation
 Existing patient demographics are not editable. To update any incorrect information, please manually enter the patient data and delete the inaccurate record. A helpful article on this process is linked here.

Patient Information

• Enter address including city, state and zip.

Although this is not required in SamaCare, it is suggested, as some payers require this information on specific forms that will be utilized. By entering this information here, this will auto-populate the needed sections of your form with this information in future steps. 

Example View

Search for JCODE/CPT code

• You can search utilizing the description of the JCODE/CPT, or by the 5 digit code itself.

Code Not Populating?
See steps here on how to request a missing code and continue with your prior authorization in seconds!

Example View

Patient Insurance Information

• All of the below information should be found from the Member ID card.
  • Insurance Type
    • Select plan type from Member ID card
      • Currently we have the following selections: Medicare, Medicaid, Commercial, Other. 
  • Member ID
    • Enter Member ID from the Member ID card
  • Issuing State
    • Select the issuing state of the plan. (This may not always be the same state the patient resides in. Check the Member ID card for the correct state). 
  • Insurance Organization
    • Select the Main Insurance Organization for the Member. (Example: Ambetter is a Marketplace, not a main insurance payer. Your Member ID card may say "Ambetter from Buckeye Health Plan". Your main payer would be "Buckeye Health Plan"). 

Insurance Organization Not Populating?
See steps here on how to request a missing payer. Fear not, for we shall get you submitting your prior authorization as soon as possible! 

Example View

Guide me to Step 4-Select Authorization Form

We're here to guide you through your prior authorization quest!