Insurance Eligibility and Prior Authorization

Adding Payers to the Organization

1. Click Organization from the left navigation panel and open the required organization's details page.

2. In the Organization details page, click RIS to expand the menu and select Payers.

3. The Payers page opens, displaying the list of existing payers. From this page, users can add new payers, edit existing payers, or delete payers.

4. Click the + (Add) icon to add a new payer. The Create New Payer drawer opens.

5. Enter the Payer Name and other fields, including Payer ID, Payer Type, and Financial Type.

6. Fill in the Address and Contact Details as required.

7. Set the payer status to Active (default) or Inactive.

8. Click Create to save the payer.

9. Once saved, the newly created payer appears in the Payers list.

Editing/Deleting a Payer Record

Follow the steps below to edit or delete a payer record:

1. Navigate to the Payers list page within the selected Organization.

2. Hover over the required payer record in the list to display the Edit and Delete icons.

3. Click the Edit icon to open the Edit Payer drawer.

4. Update the required payer details, including status, payer information, address, or contact details.

5. Click Update to save the changes. The updated information is reflected in the Payers list.

6. To delete a payer, hover over the payer's record and click and hold the Delete icon.

7. The payer record is removed and no longer appears in the Payers list.

Adding Coverage for a Patient

1. Navigate to the Patient Info page and locate the Coverage section.

2. Click the + button to open the Create New Coverage drawer.

3. In the Payer Name field, search and select a payer from the list of payers added to the organization.

4. Set the Coverage Status at the top of the Create New Coverage page.

5. Enter the patient's coverage details, including the Coverage dates Effective Range.

   By default, the Member Relationship is set to Self, and the Member Name is prepopulated with the patient's name.

6. To changethe member, select a different relationship from the dropdown and search for the appropriate member.

7. If the required member does not exist in OAI, click Add New to create a new patient record for the member.

8. After creating the new member's record, select the relationship and populate the newly created member.

9. Enter the Member ID and Group Number details.

10. Select the Employer Name by searching from the list of employers in OAI.

11. If the employer does not exist, click Add New to create a new employer record and then select it.

12. Upload the member's Insurance Card image.

13. Click Save to store the coverage information.

Adding Prior Authorization to a Patient Study

1. Navigate to the Worklist, locate and open the required patient study.

2. From the patient study page, select Prior Authorization from the top-right corner of the screen.

3. The Prior Authorization drawer opens on the left side of the screen.

   

4. In the Prior Authorization panel, the patient's coverage information is displayed at the top.

5. Under Set Authorization Request, select the appropriate value that represents the current authorization status for the study:

   • Unknown

   • Not Required

   • Pending

   • Approved

   • Denied

6. Enter the authorization details:

   • Authorization Number

   • Authorization Start Date

   • Authorization End Date

   • Total Amount Due

7. Add Notes (optional) for remarks or additional context.

8. Review all entered information for accuracy.

9. Click Submit to save prior authorization.