Step 6-Request & Patient Details

TABLE OF CONTENTS

• Request Description (Internal Use Only, to help identify requests)
  • Example View
• Request Type
  • Example View
• Patient Diagnosis
  • Example View
• Services
  • Example View
• Select "Next"
• Guide me to Step 7-Provider & Location Details

Request Description (Internal Use Only, to help identify requests)

• You have the ability to edit the description of the request if you would like to change this information.
  • This description will be shown on the preview of your authorization while managing your authorizations.
• You will also need to enter the "Start Date of Service". This will be the date you wish for the authorization approval to begin on. 

Example View

Request Type

• Is this an expedited or non-expedited request?
• Is this an initiation request or a continuation request?

Example View

Patient Diagnosis

• Enter the diagnosis code(ICD-10) by either utilizing the description of the diagnosis, or by utilizing the alpha numeric sequence. (Ex. A00.9-Cholear, unspecified.)
  • These can also be removed once added.

Multiple Diagnosis Codes?
Certain forms are limited to the number of diagnosis codes you can add. If your request requires multiple diagnosis codes and the form that is being utilized only allows a specific amount to be added, we suggest you add these additional codes to the clinical notes on the form.

If multiple codes can be added to the form you are utilizing, the feature will be available for you to select more than one.

Example: The form utilized below allows a max of 3 codes to be added. 

-Once the maximum amount of codes have been added, the search box will be greyed out and will not allow any other additions. 

Example View

-The form utilized above only allows a max of 1 code to be added. 

Services 

• The quantity will always be numerical.
• You can add up to 10 rows of codes by clicking on the "+Add Service Code". These can also be removed once added.

Example View

Select "Next"

• Select 'Next" to move to the next step in the progress! You're halfway there!

Guide me to Step 7-Provider & Location Details

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