Background:
Prior authorizations is need to be renewed to ensure continuous patient care and to prevent situations where services are rendered to a patient whose authorization has expired, leading to claim denials.
Steps
- Install Advanced Prior Auth (Oe-module-prior-authorizations) from Modules → Manage Modules
- The Advanced Prior Auth module creates a table called
module_prior_authorizations
. - This table has fields: id, pid, auth_num, start_date, end_date, cpt, init_units, and remaining_units to stores details about each prior authorization.
- To access this table from a rule filter or target, via the
custom table
option, the rules would look for apid
anddate
fields. Since there is nodate
field in themodule_prior_authorizations
table we will need to create a sql view that presents theend_date
field as a field nameddate
.- Access the OpenEMR database
- Execute the following SQL query to create a view named
v_module_prior_authorizations
:
CREATE VIEW v_module_prior_authorizations AS SELECT id, pid, auth_num, DATE_ADD(end_date, INTERVAL -6 WEEK) AS date, start_date, end_date, cpt, init_units, remaining_units FROM module_prior_authorizations;
This view calculates adate
field 6 weeks (adjust based on your need) before theend_date
of each authorization to allow enough time to renew the PA.
- The Advanced Prior Auth module creates a table called
- Set up a Clinical Rule:
- Admin → Practice → Rule → Add New
- Give it a name
- Check Active Alert and Passive Alert
- Reminder intervals: set per your work flow. I used 1 week for each
- Save. Now it is part of the Rules
- Go back to Admin → Practice → Rules and click on the Rule you just created.
- Add Demographics filter criteria and Target/Action Groups. Make sure to mirror your target criteria as a demographic filter to make the rule not applicable if no PA record is present (i.e., the rule should be applicable only if a PA record exists for a patient)
- Here is my setting.
- Admin → Practice → Rule → Add New
Acknowledgments
I would like first to thank @juggernautsei , @sjpadgett , and @hanksterr7 for thier help. I am not a developer / programmer. Set, test and adjust. If you have question ask hope someone can help.