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ShannonB
Canine II

Clearing an expired preauthorization/predetermination

Hello, I am wondering if there is a more simple solution for patient estimates. If a preauthorization has been entered in, that over rides everything. Even if the patient has a new insurance. Is there any way to clear it? Other than creating a new treatment plan every time? Moving said treatment also moves the attached preauthorization and that causes a lot of confusion and frustration on everyone's part.

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sonyap
First Molar I

@ShannonB we just learned a long time ago not to enter the pre-d approval the way that PW is configured to do.  We put a note in the tx plan contacts stating "Pred received for crown #4. Total $1500, insurance est $1000, patient est $500."  Then we make a pending appt and put the same info there.

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jdowner
Moderator
Moderator

It would be possible for you to mark it to request Pre-d again to remove the original pre-auth amount, then submit it to paper.  Once it's marked as submitted you can then right click on one of the procedures and choose "View/resubmit primary (or secondary) claim." On the claim information screen, you can then manually clear the pre-d so it clears without the authorization amount on it.  This will make it to it doesn't use the authorized amount to override the estimating. 

The only other option would be to create a new tx plan and not use the copy from option. 

Johnathan Downer | Technical Support Analyst
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tsalcido
CS Dental Employee
CS Dental Employee

Is this what you are looking for?

If you were to right click on a procedure in the group. Choose View/Resubmit

tsalcido_1-1680043157903.png

You can Clear Pre-D.

tsalcido_0-1680043116756.png

 

This will close out the claim.

However if you are wondering how it should work see below.

=====================================================

When we create a preauth the ideal way is to enter the insurance approval. The appointment card will reflect the approval amount. Once the appt has been completed the treatment is marked completed. 

Are you trying to send preauth without enteirng the approval? If so, the treatment plan will stay with the preauth sent in status until the treatment is completed.

tsalcido_0-1680042377180.png

If you do not put the approval the claim remains open.

Example

Pre Auth sent and appoval received

tsalcido_1-1680042428278.png

Enter in the appoval

tsalcido_2-1680042486780.png

 

The status is changed and the claim is closed. 

tsalcido_6-1680042886106.png

 

The appointment reflects the appoved amount.

tsalcido_3-1680042517713.png

The status is changed in the treatment plan with the approval

tsalcido_4-1680042533434.png

When the appointment is checked out the treatment is greyed out. 

tsalcido_5-1680042641554.png

 

 

 

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tshaw
Community Manager
Community Manager

Hi @ShannonB, I apologize that this was missed. Let me tag a few people that may have some suggestions. 
@tsalcido 
@Rebecca_Adams 
@jfdias68 
do any of you have suggestions for this?

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