Main Guide
Authorization Process When Patient Arrives Without Authorization
Purpose
The purpose of this guide is to provide Patient Access staff with a consistent process to follow when a patient arrives without authorization. This helps ensure authorization issues are routed through the correct communication channel, reduces duplicate calls and emails, and keeps patient flow moving as smoothly as possible.
Situation / Scenario
Use this guide when a patient arrives for their scheduled appointment and authorization has not been received or is not showing on file. This process should be followed immediately to verify whether authorization is on file and to prevent unnecessary delays in patient flow.
Step-by-Step Instructions
Before sending the email, make sure you have the following information available:
- Patient name
- Account number
- Appointment/service information, if needed
- Confirmation that authorization is not showing or has not been received
Helpful Tips
Use the exact subject line PATIENT IS HERE so the request is easy to identify.
Include the patient name and account number to help Precert locate the account quickly.
Keep the email short and clear.
Follow the same process each time to avoid confusion or duplicate communication.
Common Mistakes
Calling the physician office directly instead of emailing Precert
Calling and emailing for the same request
Leaving the account number out of the email
Using a vague subject line instead of PATIENT IS HERE
Not giving the patient the proper options if authorization is not received timely
What NOT To Do
Do not call physician offices directly for authorization status.
Do not call and email for the same authorization request.
Do not bypass the Precert distribution group.
Do not delay patient communication if authorization is not received timely.
Do not tell the patient the appointment can continue without following the proper authorization/non-coverage process.
Escalation Instructions
If there are questions about whether authorization has been received, staff should communicate through the Precert distribution group:
If authorization is not received timely, follow the required patient options:
- Initiate the Notice of Non-Coverage
- Postpone the appointment until authorization is received