Attach or request an authorization

Outcome

A charge that requires authorization has an active, valid auth attached — either an existing one in the platform, an existing one entered by hand, or a freshly-requested 278 you submit through the platform.

Prerequisites

Scope	What it lets you do
billing.charge.read	See the auth-required issue
clinical.authorization.read	View existing auths
clinical.authorization.write	Attach to the charge
clinical.authorization.request	Submit a 278

A trading partner with 278 capability for the payer, or your program is configured for MANUAL_PENDING (manual auth workflow, no 278 wire).

The auth lifecycle

Find an existing auth

The fastest path: open the member, Authorizations tab. Each row shows:

Column	Meaning
Auth number	Payer's reference.
Status	ACTIVE / PENDING / EXHAUSTED / EXPIRED.
Effective	Window of dates of service it covers.
Approved units	Total approved (visits, hours, dollars depending on payer).
Used	Units consumed by attached charges.
Procedure codes	The codes this auth covers (some payers list them; some don't).

An auth is valid for a DOS when:

• Status is ACTIVE.
• DOS is within Effective.
• Used + this charge's units ≤ Approved.
• The procedure code is in the auth's covered list (or the list is empty, meaning unscoped).

Attach an existing auth

1. Open the charge. The auth-required issue shows on the inline drawer.

2. Click Attach auth. A dialog lists candidate auths from the member's record, filtered to ones valid for the DOS. The platform ranks by remaining units descending.

3. Pick an auth and confirm. The platform increments used_units, attaches the auth ID and number to the charge, and clears the auth_required issue. Re-validate confirms.

Request a new 278

When no existing auth covers the DOS:

1. On the charge or member, click Request authorization. A dialog captures: payer, member, service code, units, dates, supporting documents.

2. The platform builds an X12 278 (005010X217) and submits to the configured trading partner. The auth row writes at status PENDING with the 278's payer reference.

3. Track the response on the member's Authorizations tab. The 278 response (also 005010X217) flips status to APPROVED, PENDED, or DENIED.

   Outcome	Move
   APPROVED	Auto-attach the auth to the originating charges via the Suggested charges link.
   PENDED	Set a follow-up date; payer is reviewing.
   DENIED	Appeal at the payer's portal or rebuild the request with corrected info.

Manual auth (no 278 wire)

For payers without 278 support — typical for some state Medicaids and smaller commercial — you call / fax / portal-submit the request and the payer mails or faxes back an authorization number. To enter:

1. On the member, click Add authorization. A form captures auth number, payer, dates, units, procedure codes.

2. Attach a supporting document (the payer's letter, fax, or portal screenshot) under Documents.

3. Save. The auth row writes at ACTIVE. Attach to the charge as above.

Auth utilization (don't run out)

The Member detail's COB / Auth panel surfaces the utilization sparkline — units used vs. approved. The dashboard's Auth utilization alerts widget surfaces auths that are >80% consumed with the period not yet over. Catch them before the next charge fails.

Validation

Check	Expected
Attaching an auth clears auth_required	Yes after re-validate.
used_units updates atomically	Yes; concurrent claims see the right balance.
278 status update is reflected on the auth row	Yes; usually within seconds.
Manual auth entry writes the supporting doc to the audit log	Yes.

Troubleshooting

Symptom	Cause	Fix
Attach auth shows no candidates	No matching auth, or filter excludes them	Toggle Show all auths and audit by hand.
278 fails with PROCESSING_DELAY	Payer system queue	Wait; the platform retries on the configured cadence.
used_units exceeds approved	A prior claim consumed too many	Reverse the offending claim or request an auth amendment.
Auth shows EXPIRED mid-bill	DOS slipped past the auth's effective range	Request a new auth or appeal a timely-filing exception with the original auth's letter.

Where to next

• 2.6 — Edit or correct a charge — when the truth is in-app.
• 3.1 — Build & submit — the next step on a clean charge.