DESCRIPTION
This CMBHS function allows Authorization Approvers to approve, deny or place in pending status, requests for service authorization submitted by Authorization Requesters.
Before You Start
- Your business entity must have a contract with DSHS that allows you to receive and respond to Requests for Authorization of Services from service provider authorization requesters.
- The user must be assigned a role (Authorization Approver) that allows him/her to document responses (approval, denial, pending) to requests for authorization of services.
- For substance abuse services, a consent to release confidential information for the Authorization Approver must be obtained by the provider/Authorization Requestor before the Authorization Approver can view the client record.
- The Authorization Approver must be in the client’s CMBHS health record, at the Client’s Workspace to document a response to a request for authorization of services.
- 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 response to a request for authorization of services.
How to Access the Authorization Page SVC047
- When the Authorization Approver logs in to CMBHS, the Service Authorization Requests page SVC047 should display.
- If the Service Authorization Requests page SVC047 does not display, go to the Toolbar at the top of the page, CLICK ON the fifth menu item, Service Authorization.
- The Service Authorization Requests page displays a list of all the requests for authorization that have been submitted and not yet acted on. Requests for Appeal are also displayed.
How to Respond to a Request for Service Authorization
- Pick a client from the Service Authorization Request List by CLICKING ON the client’s name.
- The row will highlight and that client’s request will display.
- Review the calculated level of care (LOC-C), the recommended level of care (LOC-R), the requested service type(s) and units and the client’s clinical documents to determine if the request meets the criteria/guideline for approval.
- After making a determination regarding the authorization request, document your decisions in the Service Authorization Record by checking either Approved, Denied or Pending for each service that was requested.
- Complete the remaining fields and enter a narrative if required or needed.
- Submit your response by CLICKING ON the Submit button.
- The Authorization Requester will receive a message on their Workspace that a decision has been documented by the Authorization Approver and is awaiting their review.