How to Get Prior Authorization for Treatment Planned Work

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Pre-Authorizations Recorded Class

Also called pre-authorization, prior approval, or predeterminations, some insurance plans require prior authorization for certain services before patients can receive them.  Additionally, patients may want to know the exact amount insurance will pay before consenting to treatment. 

Sensei Cloud enables you to send pre-authorizations for treatment-planned work and record the authorization reference number. After the procedures are performed, the reference number is included on the claim. 

Before requesting pre-authorization:

• The patient must have a valid insurance plan associated with their account.
• Procedures must be entered into the patient's Treatment Plan.

Creating and Sending Pre-Authorizations

To create and send pre-authorization requests:

1. From the Patient tab, select Treatment Plan. The planned treatment procedures are displayed.
2. Use the checkboxes to select one or more procedures.
3. Under Actions, select Send Pre-Authorization. Sensei Cloud creates a Pre-Auth claim and sends it to the insurance company. The Claim column for the selected procedure changes to Pre-Auth, and the claim is added to the Claims Management queue (Patient > Insurance > Claims Management or Location > Claims > Claims Management).

Recording Pre-Authorization Responses

After the patient's insurance company processes the pre-authorization request, they will respond with an explanation of benefits (EOB) verifying what procedures are covered, and the amount of the expected payment. This information should include a pre-authorization number.

To enter the number:

1. From the Patient tab, select Insurance > Claims Management.
   Note: You can also find the Pre-Auth claims by selecting Location > Claims > Claims Management and sorting by Type.
2. Select the claim for which the EOB was received. The Pre-Authorization Claim Summary is displayed.
   
3. Next to Pre-Authorization #, click Add Reference #. The Add Claim Pre-Authorization Reference # window is displayed.
4. Enter the number provided and click Save. The Pre-Auth Status of the claim is changed to Closed.

Note: After the pre-authorized work is performed and a claim is created, the Patient's Ledger will display two line items: one for the pre-auth claim and one for the claim requesting payment for the work.