DESCRIPTION
The service authorization function in CMBHS provides the method by which the provider, through their Authorization Requestor, documents a request for approval for payment for a client’s services using an automated process. The Service Authorization Request is page SVC047.
The Service Authorization List is displayed on page SVC047. There is a Provider view where providers can see the requests they have submitted for approval and status of the response. The Service Authorizer accesses the same page to view the Requests for Service Authorization that providers have submitted and access them to document a decision.
The designated Authorization Approver receives the request through CMBHS and views it on the Service Authorization List. After receipt of the Request, the Approver can accesses the clinical documentation needed to make their decision to approve or deny the request. For Substance Abuse Services, the client must have signed an Authorization for Disclosure of Information before the Approver may view the records.
The Authorization Approver documents their decision in the client record on the Service Authorization Response page, SVC034. The Authorization Requestor receives the decision and, may respond with an appeal, if appropriate. The Service Authorization List on the Administrative Tool bar displays for the Provider and for the Service Authorization Approver (an OSAR, BHO or LMHA UM Department)’
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The Authorization Requestor
The Authorization Requestor may be the clinician that evaluated the client and made the recommendation for services, or another person designated by the provider. The person fulfilling this role documents a request for authorization for services in the client’s health record and electronically submits the request to the Authorization Approver.
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The Authorization Approver
The Authorization Approver is a qualified and credentialed staff person employed by an OSAR, BHO or LMHA UM Department (or other business entity contracting with an OSAR, BHO or LMHA) that receives the request for service authorization for a client and makes a determination to approve, pend or deny the request. The person fulfilling this role may view supporting documentation in the client’s health record and then electronically submits their determination to the Authorization Requestor.
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