MEDITECH & LSS
Authorization and Referral Management (ARM)
product brief

The Authorization and Referral Management component provides health care organizations with a streamlined approach for managing authorizations and referrals. Comprehensive referrals and authorizations are easily entered and accessible during the scheduling, registration, and billing processes.

Standard Features

Integration with other MEDITECH Applications
Integration of authorizations and referrals with registration, scheduling, billing, and the recording of the patient’s medical account are crucial. This integration provides users with the following capabilities:
• Patient and subscriber data entered in Health Information Management and Revenue Cycle products is transferred automatically to Authorization and Referral Management for any patient with referral and authorization activity
• Patient data in Authorization and Referral Management is linked to and updated by Health Information Management
• The most recent insurance verification data and authorization status flows from Registration to the Authorization/Referral Management database
• Authorizations and referrals are linked to scheduled appointments, both individual and series, in Community-Wide Scheduling functionality and automatically depleted when the appointment is attended
• Authorization information is automatically updated throughout applications when a patient no-shows or cancels an appointment
• In Community-Wide Scheduling functionality, schedulers are flagged when patients are booked for appointments beyond the authorization’s expiration date or when the last remaining visit allowed by the authorization has been used or exceeded.

Medical and Practice Management Suite
MEDITECH has incorporated authorization and referral management into our Medical & Practice Management (MPM) Suite, which serves clinicians and administrative staff in practices, clinics, and other ambulatory locations. This suite includes scheduling, registration, electronic patient records, open item billing, and authorization and referral management to fully automate these facilities. The software also:
• Enables organizations to proactively manage referrals and approve/delete authorizations
• Facilitates billing by expediting and ensuring reimbursement through entering and processing authorization
• Allows clinical staff to properly enter/track referrals out of the enterprise.

Authorization and Referral Data
Authorizations and referrals for follow-up care are quickly retrieved during scheduling and registration so staff has the necessary details when needed. Authorizations and referrals, also available for viewing through the Enterprise Medical Record, ensure the latest, most comprehensive data is available. The following data is captured:
• Multiple unique authorization identifiers, including the authorization number, pre-certification number, and internal tracking number
• Status of each authorization (Pending, Approved, Denied) Referral Type (Physical Therapy, Cardiology, etc.)
• Diagnosis and CPT Codes
• Requesting provider and/or specialist that the patient has requested
• Requested provider searched for, based upon the following provider selection criteria: specialty, physician practice, gender, language, facility, and insurance
• Effective and expiration date of the authorization and referral
• Special instructions captured in queries or notes section
• Custom Referral Forms generated to meet the requirements of your organization.

The authorization and referral component contains the following information about any appointments that have been booked or attended against it:
• Approved: Number of visits approved by the patient’s insurance
• Performed: Visit has occurred; patient has been registered, services on authorization have been provided
• Scheduled: One or more appointments booked against the authorization in Community-Wide Scheduling
• Remaining: Visits/services are completely available, neither performed nor scheduled.

Referral Check Dictionary generates additional, user-specified warning messages when:
• Patient’s insurance status is not ACTIVE
• Duplicate referrals exist
• Requested provider is not in PCP’s Care Group/practice
• No referral type noted.

Referral Processing, Worklists, and Reminders
Users can expedite referral management functions by creating on-line worklists and reminders. With these features, users can:
• Prioritize requests and expedite referral management functions, instantly seeing which referrals must be reviewed immediately
• Highlight particular issues or events for later review and processing
• Process referral worklists on-line with user-defined sort criteria
• Track multiple, concurrent authorizations.

Additional Features/Reporting Capabilities
Users can download existing data from across departments and facilities to organize into useable formats via standard report writer capabilities. Specific functions include:
• Cumulative Reporting by number of referrals, by specialty, by requesting/requested provider, and by referral type
• Production of standard reports via Compiled Report Capabilities, including standard authorization and referral and patient reports, or custom report writer routines via integration with other MEDITECH applications
• Letters created in either Rich Text or Microsoft® Word®format.

Security Features
Access to viewing and editing authorizations is based on the security restrictions defined in an organization’s Access Dictionary, and is defined for specific users according to facility or database. Access to authorizations and referrals is restricted by:
• Authorization status
• Insurance
• Requesting and requested provider
• Specialty
• Location
• Action
• Referral type.

For more information, contact a MEDITECH or LSS Marketing Representative: