How to Set Up Clinical Reminders for Prior Authorization Expiration

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 a pid and date fields. Since there is no date field in the module_prior_authorizations table we will need to create a sql view that presents the end_date field as a field named date.
      • 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 a date field 6 weeks (adjust based on your need) before the end_date of each authorization to allow enough time to renew the PA.
  • 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.

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.

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@moussa do you mind if I make this a permanent part of the module?

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Absolutely, please go ahead!

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