Medical Assistant Prep / Unit 26 MAS 632 worked example, 60 to 90 seconds
Managing Authorizations and Referrals
The idea
Managing prior authorizations and referrals is a common administrative task, and it follows a sequence.
In practice
Step one: check whether the patient's plan requires authorization or a referral for the ordered service. Step two: gather the information the plan requires, such as diagnosis, the service ordered and supporting documentation from the record. Step three: submit the request by the plan's process, before the service is scheduled. Step four: record the request, the date and any reference number. Step five: follow up until a decision arrives, then record the approval or denial. Step six: tell the provider about a denial, so the provider can decide the next step.
Where people slip
An incomplete request can delay a patient's treatment, so complete each form in full before submitting it.
Your place on the trail
Every lesson rests on earlier ones and opens later ones. Tap any to jump.
Builds on
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