Authorization and Benefit Tracking

Authorization Tracking

• Do you have claims deny because you do not have a valid referral or treatment plan on file?
• MBP’s authorization tracking service will track the number of visits allowed under a treatment plan OR the end date of a referral to ensure you do not treat patients beyond the authorized number of visits or the end date of a referral.
• On a weekly basis MBP will email you two reports showing you referrals and authorizations about to expire.  See the below examples:
  • 14 Days Future Expired Treatment Authorization Worksheet.pdf
  • Expired Treatment Authorization Worksheet.pdf

Benefit Tracking

• Does your office ever have the need to know how much a payer is paid for a patient during a benefit year?  Some patients have a limit to the dollar amount of benefits during a benefit year.
  • For example, for physical therapists, Medicare has a therapy cap each year (for example, in 2015 the cap is $1940.00).
  • For chiropractors, a patient may have, for example, only $1000 of benefits for a benefit year.
• It is important to know when a patient is close to their benefit maximum so you then can notify the patient that he/she will be responsible for the charges after the benefit max is reached.
• With that in mind, MBP offers a Patient Benefits Detail Report which will show you per patient the amount of benefits the patient has for the year, a detailed itemization of what has been paid for the year, and the remaining benefit amount available.  See the below example:
  • Patient Benefits Detail Report.pdf
• This report can be provided upon request by you OR can be scheduled to be sent weekly or monthly.  By default, the report will show all patients with a benefit limit and will show for the current calendar year.
  • If your office needs a report for a patient for a different time period than the current calendar year, that report can be provided upon request.
  • For example, John Smith’s benefit year is September 1 through August 31.  You then would want to request a report for that patient for 9/1/14 through 8/31/15.
• In addition, we can track the number of annual visits allowed per year.  For example, a patient may have 20 chiropractic visits per year.
  • Note:  If a patient who has a limited number of visits per year also requires pre-authorization, we are only able to track the number of visits allowed under the pre-authorization…but would then be unable to track the number of annual visits.
  • The report provided is the same as the Expired Treatment Authorization Worksheet under Authorization Tracking above (see Expired Treatment Authorization Worksheet.pdf .  The report will show 2 or fewer visits remaining under the patient benefits.
• NOTE:  The Patient Benefits Detail Report is only available to our PremiumPlus Providers.  The report is not available for Premium Service Providers as your office has chosen for us not to post your patient and insurance payments.

Fees

• For providers enrolled in our Platinum Service, Authorization and Benefit Tracking is FREE.
• For providers enrolled in our Premium or PremiumPlus Service, Authorization and Benefit Tracking is only $29.95 per month.
• For all providers enrolled for Authorization and Benefit Tracking, if you request a report that is not one of the ones provided to you upon schedule, the fee is $5.95 per requested report.
  • For example, you require a Patient Benefits Detail Report for a patient whose benefit year is not on a calendar year basis.

Required Information

• Providers enrolled for the Authorization and Benefit Tracking Service must provide all patient benefit information (number of allowed visits per year or maximum dollar amount of benefits per year) at the time you submit a patient form to our office.
  • For providers enrolled in our Platinum Service, eligibility and benefit verification is included as part of the service.  Therefore, when we obtain the benefit information from the payer we will have the required benefit information to track.
• For any changes to patient benefit information, providers can submit a secure ticket in our Support Suite with updated insurance information.
  • Example:  John Smith has new benefits as of January 1, 2015.  He now has a $1000 deductible and a maximum of 20 visits per year.
• For providers enrolled for the Authorization Tracking Service, providers must submit a secure ticket in our Support Suite with the authorization information.
  • Example:  John Smith has pre-authorization # 123456 good for 6 visits from 3/1/15-5/1/15.