296 - Apollo requests approval

04/18/22 Apollo approval management and charges addition

 

When delivering several orders of services and medications for one single patient their total amounts will all be added one after the other, allowing you to charge insurance companies through Apollo approval only those that still meet the approval threshold set for the product category to which these services and medications belong, allowing you to create several limits configurations of one single policy, by creating new scenarios where you can mix patient type and product classes.

This information can be set on Insurance Policy Manager, where you can select and create policies and set the Approval Threshold and other Limits to a Product Class for their insurance coverages depending on the type of patient.*

*Policies mus be assigned onto a patient in Patient Registration window for them to be covered.

You can also set if a policy will automatically require pre-authorization, if so, any charge will be automatically sent for their approval:

Take these notes into consideration:

• Any charges below the limit will be approved unless they have been marked as charges that require pre-authorization.

• Any charges above the limit will be automatically rejected and appear as pending.

• If the amount of charges exceeds the limit, then the previous last charge will be rejected.

Here is an example about this approval logic:

Policy Limit: 210 SAR

1. Charge 1 for 100 SAR - Approved Current total: 100 SAR

2. Charge 2 for 100 SAR - Approved Current total: 200 SAR

3. Charge 3 for 50 SAR - Pending Current total 250 SAR

In this example, Charges 1 and 2 still meet the 210 limit (total 200) but Charge 3 doesn't so it was rejected and requires authorization.

Please consider that the limit threshold can be set for a certain product category only, allowing you to discharge medications, laboratory services, image services and other services independently. Check cases here.

How it works:

1. Creation of Service Orders

Physicians can create Service orders on Physician Dashboard by entering Orders icon:

Then choose Services tab and add all of the services that you require from Image and Laboratory Depts:

Save.

2. Service requests validation

As you can see in our example, three out of four service requests were approved since they still meet the approval limit:

3. Pending Order Authorization window

When any order has not been automatically approved, you can send them to NPHIES for their approval on Pending Order Authorization window, where you can also track their NPHIES response and status. Here you can also edit these orders or remove them.

NPHIES (National Platform for Healthcare Information Exchange Services) is a national platform for health information exchange services and it connects all of the Healthcare insurance companies. To learn more about TPAs, major and minor insurance companies, click here.

In our example, the previously rejected order appears as pending so you can send it individually for its approval since it exceeds the policy limit:

 

 

More about POA window.

4. Multibilling

All of the approved services can covered by the policy. If you want to bill your charges in multiple extensions go to Multibilling window to assign these charges and collect them. Here you can also set the deductible amounts and copy policy discounts before sending these charges.

To collect an extension, select your charges, assign them and then Process to generate a new receipt:

 

After this you can now collect the Payment:

More about Multibilling window.

We hope this improves your Cirrus experience. Remember to share this information and ask for help if you need it. Date: April 18, 2022.