Connecting prior auths to the getMiscBillingOptions method

juggernautsei · May 22, 2023, 7:25pm

I am putting around in the billing again trying to find a way to collect the information that is in the prior auth table to be consumed in the billing. I am trying to automate the process. Since the prior auth table has the CPTs. We should be able to match the active auth to the claim and enter the auth number.

What are your thoughts on this automation?

If anyone has done this already. Care to share. @mdsupport

stephenwaite · May 23, 2023, 10:44am

hi @juggernautsei, maybe you could have a listener when saving the fee sheet?

mdsupport · May 23, 2023, 3:26pm

Is there any codified information in prior auth form?

Describe the flow you have in mind.

juggernautsei · May 24, 2023, 4:36pm

Hi @stephenwaite , I can’t picture how that would work seeing in the code that the auth right now is saved in the form_misc_billing_options. What do you envision the listener doing?

@mdsupport in the advanced prior auth table. The auths are saved with the billing codes that are associated with them. So, there is some codified information in the table. The table contains the auth expiration date.

I was thinking about expanding this into another class or expanding the logic here. The system would need to get a list of the auths that are not expired. Then, the system would need to look at the CPT codes for that encounter to determine if there is a match to any of the auths that are not expired.

If a match is found, return the auth.

github.com

openemr/openemr/blob/48ec310a7954d304aa0b11fadea408e9f6813648/src/Billing/Claim.php#L169

      
        
            }
            
            
public function getInsuranceNumbers($payer_id, $provider_id)
            {
                $sql = "SELECT * FROM insurance_numbers " .
                    "WHERE (insurance_company_id = ? OR insurance_company_id is NULL) AND provider_id = ? " .
                    "ORDER BY insurance_company_id DESC LIMIT 1";
                return sqlQuery($sql, array($payer_id, $provider_id));
            }
            
            
public function getMiscBillingOptions($pid, $encounter_id)
            {
                $sql = "SELECT fpa.* FROM forms JOIN form_misc_billing_options AS fpa " .
                    "ON fpa.id = forms.form_id " .
                    "WHERE forms.pid = ? AND forms.encounter = ? AND " .
                    "forms.deleted = 0 AND forms.formdir = 'misc_billing_options' " .
                    "ORDER BY forms.date";
                return sqlQuery($sql, array($pid, $encounter_id));
            }
            
            
public function getReferrerId()

In theory, the auth would have to be matched by pid, cpt, and expiration date greater than today.

stephenwaite · May 24, 2023, 4:55pm

when the fee sheet is saved check the mbo table and see if an auth is there and display it, if not then try to find one in the prior auth module?

mdsupport · May 24, 2023, 8:36pm

Is it form_prior_auth table? Or maybe I am clueless so I better sign off. Before doing that, here is an excellent overview of where business is headed. So it will help this project if all development efforts are directed towards implementing one or more process boxes.

Best.

juggernautsei · May 24, 2023, 8:53pm

@mdsupport
module_prior_authorizations is the table in the database where the data is stored.

juggernautsei · May 24, 2023, 8:54pm

@stephenwaite what is the purpose of displaying it? Shouldn’t it be inserted in the claim during the claim processing?

stephenwaite · May 24, 2023, 8:55pm

it can’t be inserted if it isn’t in the mbo table

thinking that it would be an enhancement because currently when the biller goes to the manager only a green button would indicate if there’s something in the mbo but doesn’t provide any info unless that button is clicked and the mbo is opened