Creating predeterminations

You can create a predetermination (pre-authorization) for a patient's treatment plan to send to the insurance carrier.

To create a predetermination

1. How to get there

   1. If the correct patient is not already selected, use the Patient Search box to access the patient's record.

      Note: You can include inactive patients in the search results by setting the Include inactive patients switch to On.

   2. Do one of the following:

      • On the Patient menu, under Clinical, click (or tap) Treatment Planner.

      • On the Patient menu, under General, click (or tap) Overview. The patient's Overview page opens. Click (or tap) the Treatment Plan box.

        

      The patient's clinical record opens with the Tx Planner tab selected.

   On the Tx Planner tab of a patient's clinical record, under Active, select a treatment plan.

   

   Note: If any of the procedures in the case require a predetermination, according to the patient's primary insurance plan settings, a Predetermination Required symbol appears next to the case name unless none of those procedures are flagged as being billed to insurance.

   The procedures (arranged by visit) that are associated with the selected treatment plan appear.

   

   Note: If any of the procedures in a visit that are being billed to insurance require a predetermination, according to the patient's primary insurance plan settings, a yellow warning message appears, and a Predetermination Required symbol appears next to those procedures. However, for any procedure that requires a predetermination but is not flagged as being billed to insurance, the corresponding Predetermination Required symbol is gray , but you can edit the procedure to flag it as being billed to insurance if you want to include the procedure on the predetermination.

2. Select the checkboxes of the procedures in a visit that you want to include on a predetermination.

   Notes:

   • You can choose not to include procedures with a Predetermination Required symbol , and you can choose to include procedures without the symbol.

   • A predetermination cannot include procedures from multiple visits. You must create separate predeterminations for procedures in separate visits.

3. From the Create menu, under Predetermination For, click (or tap) the insurance plan that you want to create a predetermination for.

   

   Note: When you create a predetermination for a procedure with a Predetermination Required symbol , the symbol for that procedures turns green to indicate that it is attached to a predetermination.

   The Predetermination Detail dialog box appears.

   

4. Change the details of the predetermination as needed.

5. Click (or tap) Submit.