Page# SVC047

Service Authorization Requests

SERVICE AUTHORIZATION REQUEST LIST

The Service Authorization List, page SVC047, displays information for both the Provider and the Authorization Approver about the requests for Authorization that have been submitted and their status in the request – approval cycle.

Before You Start

Your business entity and service location must have a contract with DSHS that allows you to document and submit requests for authorization of services.

The user must be assigned the role of Authorization Requestor to allow him or her to document a request for authorization of services in CMBHS.

Verify that you have the correct client by checking the client’s name and at least one other identifier at the top of the page before you begin to document a request for authorization of services.

You must be in the client’s CMBHS Health Record, at the Client Workspace, to document and submit a request for authorization of services.

For Substance Abuse Service Providers Only

For Substance Abuse Services, a complete and unexpired Financial Eligibility Assessment must be in the client record before the Authorization Requestor can request authorized for services.

Also, the eligibility status must be Eligible for DSHS Funded Services, or Eligible for partial DSHS Funded services.

For Substance Abuse Services, an Authorization for Release of Health Information must be in the client record releasing information to the Authorization Approver and consent for the Authorization Approver to release client identifying information back to the Authorization Requester.

For NorthSTAR Services (MH and SA Clients)

The Approver cannot view progress note type “counseling” without consent from client.

“Utilized Units” refer to Progress Note service units where the Progress Notes has been saved as “Ready for Review” or “Closed Complete”.

An overlapping Service Authorization can only be closed if the service type for all of the Progress Note that fall within the new authorization date range are still authorized (the service is approved and has one or more units).

Business Rules

If the Authorization Requester submits a request for authorization for a client and there is already an open authorization for that client, then the system displays the message “There is already an open authorization for this client, are you sure you want to continue?”

If the user chooses Yes, the system closes the previously existing Authorization for Services by setting the Authorization End Date to one day before the new Authorization Begin Date.

An open authorization is determined by the authorization begin and authorization end date. The authorization is open on the begin date and closed on the end date.

There cannot be more than one authorization open, per client per admission to a provider.

If a client has a substance abuse admission and a mental health admission to the same provider at the same time and both services require authorization, then the client would have two admissions and one authorization for each admission.

There are some rules regarding Authorization Approver access to client clinical record. For SA this includes any clinical document that the Approver (OSAR) created plus any clinical document that the client gives consent to view.

For MH, this includes all clinical documents created by any Local Mental Health Authority (LMHA) or MH service provider contracting with an LMHA or DSHS to provide services.

How to Access the Request for Authorization Page

To Access the Request for Authorization function you have selected a client and at the Workspace for that client.

Go to the Client Services toolbar on the left, pick Request Service Authorization by CLICKING ON it with your pointer.

The Request Service Authorization page SVC047 will display.

How to Request Service Authorization

When the Service Authorization Requester opens the Request Service Authorization page, information from the Recommended Level of Care (LOC-R) in the most recent completed Assessment displays in the authorization request record.

The Service Authorization Requester enters all the required information in the Authorization Request Record. The requester may view the service descriptions for each service type.

CLICK HERE for information about completing the Request for Authorization for Substance Abuse Services data fields.

CLICK HERE for information about completing the Request for Authorization for Mental Health Services data fields.

How to Edit a Request for Authorization

The end date cannot be edited past the maximum time allowed for that service package. For example, the authorization date range cannot be more than 7 days for crisis services.

The end date may not be changed to a date that causes already delivered services to be unauthorized. A service will be unauthorized if the date the service was delivered is a date that is past the new authorization end date.

For Mental Health Services For Substance Abuse Services

Level Of Care Calculated (System Generated) Level Of Care Calculated

Answer Choices:
Answer Choices:

Adult Mental Health Service Package 0

Adult Mental Health Service Package 1

Adult Mental Health Service Package 2

Adult Mental Health Service Package 3

Adult Mental Health Service Package 4

Adult Mental Health Service Package 5

Adult Substance Abuse Service Package 0

Adult Substance Abuse Service Package 1

Adult Substance Abuse Service Package 2

Adult Substance Abuse Service Package 3

Adult Substance Abuse Service Package 4

Adult Substance Abuse Service Package 5

Rules:
Rules:

This field will pre-fill according to the results of the Assessment.

If the Assessment has not been completed at the time that the authorization is requested, the Level of Care Calculated will default to Pre admission.

This field will pre-fill according to the results of the Assessment.

If the Assessment has not been completed at the time that the authorization is requested, the Level of Care Calculated will default to blank.

Level Of Care Requested

(Required for Mental Health services documentation)

Level Of Care Requested

(Required for Substance Abuse services documentation)

Answer Choices:

Answer Choices:

Adult Mental Health Service Package 0

Intensive Residential Services

Adult Mental Health Service Package 1

Supportive Residential Services

Adult Mental Health Service Package 2

Adult Mental Health Service Package 3

Adult Mental Health Service Package 4

Adult Mental Health Service Package 5

Rules

Rules:

Level of Care Requestedwill default to 'None Selected' because there are no services types associated with pre-admission (which is the default) that can be authorized.

Level Requested will default to 'none selected'.

Pre-admission will not be a selectable service package in Level of Care Requestedor Level of Care Approved.

Service Package Length
Service Package Length

(Required for Mental Health services documentation)
(Required for Substance Abuse services documentation)

Answer Choices:
Answer Choices:

Reason For Deviation

Reason For Deviation

(Required for Mental Health services documentation)

Consumer Need

Consumer Choice

Continuity of Care per UM Guidelines

Resource Limitations

(Required for Substance Abuse services documentation)

Consumer Need

Consumer Choice

Continuity of Care per UM Guidelines

Resource Limitations

Rules: Rules:

Other Deviation Reason

(Required for Mental Health services documentation)

Rules:

Other Deviation Reason

(Required for Substance Abuse services documentation)

Rules:

Begin Date

(Required for Mental Health services documentation)

mm/dd/yyyy

Begin Date

(Required for Substance Abuse services documentation)

mm/dd/yyyy

End Date

(Required for Mental Health services documentation)

Format: mm/dd/yyyy

End Date

(Required for Substance Abuse services documentation)

Format: mm/dd/yyyy

Rules: Required

Rules: Required

The End Date can be editable for approver Initiated authorizations.

Editing the authorization date range rules.

The end date cannot be edited past the maximum time allowed for that service package.

For example, the authorization date range cannot be more than 7 days for crisis services.

The end date may not be changed to a date that causes already delivered services to be unauthorized.

A service will be unauthorized if the date the service was delivered is a date that is past the new authorization end date.

The End Date can be editable for approver initiated authorizations.

Editing the authorization date range rules.

The end date cannot be edited past the maximum time allowed for that service package.

For example, the authorization date range cannot be more than 7 days for crisis services.

The end date may not be changed to a date that causes already delivered services to be unauthorized.

A service will be unauthorized if the date the service was delivered is a date that is past the new authorization end date.

Authorization Narrative Authorization Narrative

This field is optional for Mental Health users.

(Required for Substance Abuse)

This field is optional for SA users except when approved units change or the first time the approved units are different from the defaulted requested units

OR

Any health services are ("Pended" or "Denied")

OR

The LOC-R is different than the LOC-C.

Max length: Unlimited Max length: Unlimited

For Substance Abuse Services

The Reason for Deviation should be Read-Only for Approver in Requester Initiated scenario and Editable for Approver Initiated scenario.

How to Edit a Request for Authorization

The end date cannot be edited past the maximum time allowed for that service package. For example, the authorization date range cannot be more than 7 days for crisis services.

The end date may not be changed to a date that causes already delivered services to be unauthorized. A service will be unauthorized if the date the service was delivered is a date that is past the new authorization end date.

NEXT,

CLICK HERE to go to 'DAY RATE ATTENDANCE RECORD'

For Mental Health Services	For Substance Abuse Services
Level Of Care Calculated (System Generated)	Level Of Care Calculated
Answer Choices:	Answer Choices:
Adult Mental Health Service Package 0 Adult Mental Health Service Package 1 Adult Mental Health Service Package 2 Adult Mental Health Service Package 3 Adult Mental Health Service Package 4 Adult Mental Health Service Package 5	Adult Substance Abuse Service Package 0 Adult Substance Abuse Service Package 1 Adult Substance Abuse Service Package 2 Adult Substance Abuse Service Package 3 Adult Substance Abuse Service Package 4 Adult Substance Abuse Service Package 5
Rules:	Rules:
This field will pre-fill according to the results of the Assessment. If the Assessment has not been completed at the time that the authorization is requested, the Level of Care Calculated will default to Pre admission.	This field will pre-fill according to the results of the Assessment. If the Assessment has not been completed at the time that the authorization is requested, the Level of Care Calculated will default to blank.
Level Of Care Requested (Required for Mental Health services documentation)	Level Of Care Requested (Required for Substance Abuse services documentation)
Answer Choices:	Answer Choices:

Adult Mental Health Service Package 0	Intensive Residential Services
Adult Mental Health Service Package 1	Supportive Residential Services
Adult Mental Health Service Package 2
Adult Mental Health Service Package 3
Adult Mental Health Service Package 4
Adult Mental Health Service Package 5
Rules	Rules:
Level of Care Requestedwill default to 'None Selected' because there are no services types associated with pre-admission (which is the default) that can be authorized.	Level Requested will default to 'none selected'.
Pre-admission will not be a selectable service package in Level of Care Requestedor Level of Care Approved.
Service Package Length	Service Package Length
(Required for Mental Health services documentation)	(Required for Substance Abuse services documentation)
Answer Choices:	Answer Choices:
Reason For Deviation	Reason For Deviation
(Required for Mental Health services documentation) Consumer Need Consumer Choice Continuity of Care per UM Guidelines Resource Limitations	(Required for Substance Abuse services documentation) Consumer Need Consumer Choice Continuity of Care per UM Guidelines Resource Limitations
Rules:	Rules:
Other Deviation Reason (Required for Mental Health services documentation) Rules:	Other Deviation Reason (Required for Substance Abuse services documentation) Rules:
Begin Date (Required for Mental Health services documentation) mm/dd/yyyy	Begin Date (Required for Substance Abuse services documentation) mm/dd/yyyy
End Date (Required for Mental Health services documentation) Format: mm/dd/yyyy	End Date (Required for Substance Abuse services documentation) Format: mm/dd/yyyy
Rules: Required	Rules: Required
The End Date can be editable for approver Initiated authorizations. Editing the authorization date range rules. The end date cannot be edited past the maximum time allowed for that service package. For example, the authorization date range cannot be more than 7 days for crisis services. The end date may not be changed to a date that causes already delivered services to be unauthorized. A service will be unauthorized if the date the service was delivered is a date that is past the new authorization end date.	The End Date can be editable for approver initiated authorizations. Editing the authorization date range rules. The end date cannot be edited past the maximum time allowed for that service package. For example, the authorization date range cannot be more than 7 days for crisis services. The end date may not be changed to a date that causes already delivered services to be unauthorized. A service will be unauthorized if the date the service was delivered is a date that is past the new authorization end date.
Authorization Narrative	Authorization Narrative
This field is optional for Mental Health users.	(Required for Substance Abuse) This field is optional for SA users except when approved units change or the first time the approved units are different from the defaulted requested units OR Any health services are ("Pended" or "Denied") OR The LOC-R is different than the LOC-C.
Max length: Unlimited	Max length: Unlimited