Main Guide

Registrar/Pre-Registration/Authorizations Registrar

Active

Purpose

To ensure all patients scheduled for services requiring prior authorizations have the necessary approvals obtained before the date of service, minimizing delays in care, and supporting accurate reimbursement.

Step-by-Step Instructions

1.     Review Scheduled Accounts

Helpful Tips

  • Verify insurance eligibility before beginning the authorization process.
  • Review payer-specific authorization requirements for every account, even for returning patients.
  • Submit authorization requests as early as possible to allow time for payer review.
  • Document every payer contact, reference number, and authorization update in Expanse.
  • Monitor pending authorizations daily to avoid delays in patient care.
  • Notify scheduling and the ordering provider immediately if authorization issues may impact the scheduled service.

Common Mistakes

Issues:

  • Missing Clinical Information- resolution: contact provider office immediately to request and track until received.
  • Insurance Interactive or Incorrect- resolution: verify with patient or provider correct insurance information and update account information.
  • Payer Portal Unavailable- resolution: use alternate submission method or contact payer directly.
  • Incorrect or Missing CPT/ICD-10- resolution: confirm with provider before submission to insurance company.
  • Authorization Pending Near Service Date- resolutions: escalate to Team Leader, call MD office to postpone, or notify patient of need to postpone.

Pain Points:

  • Scheduling Adding on Last Minute Appointments- reduces times frame to review for authorizations, causes patients to be delayed in care until authorizations can be obtained.
  • Scheduling Not Verifying Demographic Information- reduces ability to contact patients. Causes extra for pre-registration to review incorrect insurances, or causes additional phone calls to MD offices to obtain demographic information.
  • Scheduling Making Duplicate Accounts, Scheduling Wrong Patients, and Scheduling Wrong Test- Pre-registration is taking extra time to review accounts and to sending emails to Manager to correct.

What NOT To Do

  • Do not assume an authorization is not required based on previous visits. 
  • Do not submit authorization requests with incomplete clinical documentation. 
  • Do not schedule or confirm services without verifying authorization requirements. 
  • Do not leave pending authorizations without documented follow-up. 
  • Do not ignore payer requests for additional information. 
  • Do not document authorization approvals without verifying approval details, dates, and approved services. 
  • Do not allow patients to arrive for services when authorization issues remain unresolved without notifying leadership and the ordering provider.