Main Guide

Registrar/Pre-Registration/Authorizations Registrar

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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.

1.     Review Scheduled Accounts

  • Access daily schedules and registration worklist
  • Identify patients scheduled for procedures, surgeries, imaging, or other services requiring prior authorizations.
  • Prioritize accounts based on service date, urgency, and payer turnaround times.


**Key Point: Review accounts as soon as they are scheduled to allow sufficient time for processing.


2.     Verify Insurance Eligibility and Benefits

  • Confirm active insurance coverage for date of service.
  • Verify patient demographics, subscriber information, and policy details.
  • Determine if prior authorization, pre-certification, or referral is required.


**Key Point: Eligibility verification must be completed before initiating the authorization process.


3.     Determine Authorization Requirements

  • Review payer specific guidelines for the scheduled service.
  • Confirm whether the CPT code requires authorization.
  • Identify any additional documentation or medical necessity criteria.


**Key Point: Requirements vary by payer and plan, always verify current guidelines.


4.     Gather Required Documentation

  • Obtain physician orders, clinical notes, rest results and supporting documentation.
  • Verify accuracy of CPT, 1CD-10, and provider information.
  • Ensure all required documentation is complete before submission.

**Key Point: Complete and accurate documentation reduces processing delays.


5.     Submit Authorization Request

  • Submit authorization through the payer portal, by phone, or by fax according to payer requirements.


**Key Point: Follow payer specific submission instructions to avoid rework or delays.


6.     Monitor and Follow-up on Pending Request

  • Track all pending authorizations on the worklist.
  • Follow-up with payers within established turnaround times.
  • Escalate urgent or delayed requests when necessary.


**Key Point: Consistent follow-up help prevent service delays and denials.


7.     Document Authorization Outcome

  • Record authorization number, approved services, units, effective dates, and any limitations.
  • Update the patients account in Expanse.
  • Notify patient of approval, denial, or pending status. If not approved or pending inform patients of need to postpone services.


**Key Point: Accurate documentation ensure continuity across departments.


8.     Address Denials or Additional Information Request

  • Review denials reasons or payer request for additional information.
  • Coordinate with provider office to obtain missing information or peer to peer request.
  • Submit reconsiderations, corrections or have MD peer to peer with insurance company.


**Key Point: Prompt resolutions reduce delays in patient care.


9.     Final Pre-Service Verification

  • Confirm authorization is approved and valid for date of service.
  • Ensure authorization matches the schedule procedure, diagnosis, and location.


**Key Point: Final verification prevents avoidable authorization related denials.


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.