- Lab
- Radiology
- Procedure
- Consult
- Prescription (Rx)
- Items/DME
Note:
- If the Requires Authorization checkbox is unchecked from Encounter Types Master screen for an Encounter Type after the RFA number is generated for that Encounter, then the corresponding RFA entry will still be displayed on PreAuth Tracking screen.
- If the Requires Authorization checkbox is checked for an Encounter Type after the respective tests (Lab, Radiology, Procedure, Consult (In-House/External), Items/DME, Prescription (Rx) [In-house / External]) were ordered, then an RFA entry will NOT be created and displayed on PreAuth Tracking screen.
The admin-level property rfa.order.groupbytype displays the following values:
- 0-Bundled RFA
- 1-RFA for Order type
- 2-RFA for Order test
- When the value is set to “0- Bundled RFA”, the system creates bundled RFA where all types of tests are bundled into one single RFA order.
- When the value is set to “1-RFA for Order type”, the system creates separate RFA orders according to the type of test for Lab/Radiology/Consult/Procedure/Prescription/Item.
- When the value is set to “2-RFA for Order test”, the system creates separate RFA for each test. For instance: If an Encounter has 4 Lab Orders and 3 Radiology Orders associated with it, then 7 RFA’s are created on the PreAuth Tracking screen.
- Patient
- PreAuth Status
- DOI (Date of Injury)
- Case
- Body Parts
- Type
- Status
- Provider
- Visit Location
- Follow Up Date
- DOS (Date of Service)
- Patient
- Insurance
- Response
- Worked Date
- Case Ins. Classified As
- Enc. Ins. Classified As
- Visit Type
- Track Status
- Worked By
- Stat
- Order Description
- If the urgency of a Lab or Radiology Order is selected as Stat from the Type dropdown on CPOE Lab/Radiology Order screen, Encounter TOC Lab/Radiology Order screens or Order Sheet Lab/Radiology tabs,
then on CPOE PreAuth Tracking screen, an exclamation mark
is displayed in front of such orders, implying that they are urgent and need to be given preference while processing orders. - RFA Orders for which the associated tests are deleted from the Order screen are not diplayed on the Left Panel of the screen and on the RFA Tracking search popup.
- When the value PreAuth Tracking is set in the prognocis.display.locationbrfname.forscreens property,on the Visit Location column of Manage Columns the system displays the location's Brief Name instead of the Complete Name on the PreAuth Tracking screen.
- Header Band
- Tests and Orders List section
- Patient Name and associated unique RFA number
- Date of Service
- Provider Name
- Patient’s Progress Notes
- Date of Injury
- Case Number
- Status
- RFA Notes
- Insurance
- Open: This status is displayed when the RFA Response Status for all tests is Unprocessed (i.e. when an RFA is created).
- In Progress: This status is displayed when the RFA Response Status for at least one test is Denied / Appeal / Appeal Sent / In Process / Pended / RFA Sent.
- Approved and Ready to Close: This status is displayed when the RFA Response Status for all tests is either Approved or Modified.
- Ready to Close: This status is displayed when the RFA Response Status for at least one test is Withdrawn / PA Not Required / Sandhagen and no tests are in Denied / Appeal / Appeal Sent / In Process / Pended / RFA Sent status.
- Close: This status is not auto-updated and must be manually selected by clinic users when the RFA is to be closed.
- If the Status of an RFA is Approved and Ready to Close or Ready to Close, and a user adds a new test in the same encounter, the Status auto-updates to Open to indicate the presence of unprocessed tests.
- If the Status of an RFA is In Progress, and a user adds a new test in the same encounter, the Status remains In Progress.
- If the Status of an RFA is Close, and a user adds a new test in the same encounter, the Status auto-updates to Open.
- Test Name
- Type
- RFA Response
- Reference
- Remove from RFA
- For Lab, Radiology, Procedure and Prescription along with the name, the system also displays the ICDs and CPTs.
- For Consults the system displays the name of the Consult Order along with ICDs and CPTs.
- For Items along with the name, the system displays the manufacturer details, ICDs and CPTs.
- For DME along with the manufacturer details, ICDs and CPTs, the system displays the DME name.
- RFA Sent
- Approved
- Denied
- Modify
- Sandhagen
- PA Not Required
- Appeal
- Appeal Sent
- Text field: To add test-specific notes for each order test at row level.
There is no character limit for this field.
The notes added in this field are retained on saving even if the user turns the property rfa.show.notes.for.orders Off.
Since these notes are test-specific, any data added in this field is not reflected in the RFA Notes popup invoked on clicking the header-level Notes icon
. 
Insert Phrases search icon :
On clicking this icon, a Request For Authorization Phrases popup is displayed where user can add or edit notes for this popup or select already available notes and add them to the < Test Name > Notes popup.
Any notes added to this search by clicking on the Add/Edit button are available for the Notes icon on header-level as well as on row-level. - Ok button: On click, saves the added notes or any changes made to already existing notes in this popup and closes the popup.
- Cancel button: On click, closes the popup without saving the changes.
- Test Name
- Type
- All the patient related conditions which are currently available in the TO drop-down of Letters-out screen
- Insurance Companies
- Address Book
- Providers
- Patient
- Insurance Companies
- Address Book
- Attorney
- Adjuster
- Employer
- Employer Depts.
- Employer Users
- Employer TPAs
- Surescripts directory (for Secured messaging)
- ICDs and CPT/HCPC codes associated with Items marked as Sale Items or DME from Items/DME Master screen can be included in the RFA Letter sent for Items or DME orders.
If the tags ENC_RFA_DWC25_TBL and ENC_RFA_DWC25ALL_TBL are used in the RFA Letter template,
then the following information is printed in the DWC25 and DWC25ALL tables in the RFA Letter:
- Diagnosis: Prints ICD codes present on Assessment screen for the Items/DME.
- ICD-Code: The ICD code from Assessment screen.
- Service/Good Requested: The name of the Item/DME.
- CPT/HCPCS Code: The CPT and HCPC codes assigned to the Item/DME from Items/DME Master.
- Other Information : Prints the reason added in Reason field on Encounter TOC → Items/DME.
- If the ENC_RFA_SELECTED_TESTS tag is used in the Letter template, then the following information is printed in the RFA_Selected table in the RFA Letter:
- Order(s): The name of the Item/DME.
- CPT Codes:The CPT and HCPC codes assigned to the Item/DME from Items/DME Master.
- Type: IT to indicate Items/DME.
- ICDs: Prints ICDs associated with DME from Encounter TOC → Items/DME.
-
The ENC_DMEITEMS tag prints DMEs ordered in the encounter in the following format:
- DME Name: Prints Name from Items/DME Master.
- Unit: Prints Stocking Unit from Items/DME Master.
- Manufacturer: Prints Manufacturer from Items/DME Master.
- CPT/HCPC: Prints codes added to CPT/HCPC button from Items/DME Master.
- ICD codes: Prints ICDs associated with the DME from Encounter TOC → Items/DME.
- Reason: Prints Reason from Encounter TOC → Items/DME.
- Dispensed: Prints Yes or No depending on status on Encounter TOC → Items/DME Master.
- OK: By clicking on the OK button the selected response/appeal gets deleted.
- Cancel: By clicking on the Cancel button the warning message popup gets close without deleting the response/appeal letter.
- Case No. and Date of Injury on Case Management popup.
- Patient's Case Number associated with the RFA Encounter on Start New Encounter screen..
- AddLine1, City, State, ZIP fields on Employer Master.
- AddLine1, City, State, ZIP fields on Locations Master.
- Clinic Contact data such as name, telephone, fax number and email address in the following properties on the Properties Master screen: rfa.office.manager.name, rfa.office.manager.telephone, rfa.office.manager.fax and rfa.office.manager.email.
- A unique Other Claim ID on rfa.otherclaimid.from for which details are required in the below fields depending upon the option selected in the properrty:
- Case No field, WCAB# field or External ID field on Case Management popup.
- Group No. field or Subscriber ID field on Patient Insurance popup.
Note:
For Consult orders, an entry is created on the PreAuth Tracking screen even when the Consult To/Refer To Provider has not been associated to the Consult Order
on the Order Sheet screen.
The entire PreAuth Tracking screen is divided into two panels and both the panels can be enlarged using the Expand LHS
and Expand RHS 
icons provided in the partition.
Left Panel
The Left Panel of the PreAuth Tracking screen displays a list of RFA Orders that need to be processed. It consists of Filter functionality, Search Patient field, Manage Columns icon, and below these, a list of RFA Orders is displayed in a table that has the following columns:
Note:
Predefined Filters icon:
Click on this icon to apply screen level filters from the ist of predefined filters displayed.
On clicking this icon, the Filters popup is invoked that has a list of predefined filters.
To apply any of the predefined filters to the screen, click on a filter name.
Each predefined filter has an arrow icon beside its name.
On clicking that icon, a Add New Filter icon: This icon is present on the top left corner of the Filters popup for only those users who have been assigned the User Role RFA Filter Edit from the User Roles screen. Users having this role assigned can make changes in the existing predefined filters in the Filters popup and can perform Apply, Save, Save As and Delete actions on predefined filters. Users who do not have this role assigned can only make temporary changes in the predefined filters and apply them on the PreAuth Tracking screen. Such changes remain on the PreAuth Tracking screen as ad-hoc filters and the original predefined filters do not change. When the User selects any other predefined filter, the ad-hoc changes made in the previous predefined filter are reverted.
Clear All Filters hyperlink: Click on the Clear All Filters hyperlink to remove the selected filters.
Selected Filter: The applied filter's name is displayed as a hyperlink in front of the Selected Filter field. When a filter is applied to the screen, a green dot appears on the Filter icon
.
Search Patient: Enter a patient name or case number in this field to search RFA requests. This is an auto-complete search field.
Patient Search:
Click this icon to invoke the Patient Search popup.
Users can select the required patient from the list of RFA-eligible patients displayed.
Patient column: This column displays the name of the patient (eg. Mr. Dummy John) and a unique RFA number (eg. RFA00168) below the patient's name.
Date of Service: This column displays the Encounter Date of the entry of that specific PreAuth.
Case: This column displays the Case Number, if any, of the respective RFA entry. If a case number is not present for any RFA entry, then this column displays a hyphen (-) indicating to the User that there is no case number associated with this entry.
Response: This column displays the total count of all responses (read/unread) received towards an RFA. For every individual (row level) entry, a Response icon:
and the total count of responses received are displayed next to it. Even if one response is unread, then this Response icon is displayed in yellow color:
indicating the User of an unread response.
Note:
If there are no responses received for corresponding RFA entries, then no Response icon will be displayed.
Instead only the total count of responses will be displayed as 0.
Status: This column displays the status of the RFA. By default, only RFA(s) that have status marked as Open are displayed in this table. Filters are available for Status column which allows users to filter data based on the status of the respective RFA request. The available statuses are Open, In Progress, Approved and Ready to Close, Ready to Close, and Close.
Note: When a PrognoCIS User having User Roles PreAuthAdminCoordinator or PreAuthCoordinator logs into PrognoCIS and navigates to the PreAuth Tracking screen, then this user can see Edit icon available against the PreAuth Order.On clicking the Edit icon, the PreAuth Tracking popup is invoked. The changes made on this popup are autosaved and auto populated on all the respective columns of left-hand side of PreAuth Tracking screen.Right Panel
On selecting the an RFA entry in the Left Panel, all orders associated with that RFA are displayed in the Upper Right Panel. This panel is further divided into two parts:This band displays information relative to the RFA entry selected in Left Panel. List of details displayed in Header Band are as follows:
Date of Service: This field displays the Encounter Date of the RFA entry.
Progress Notes icon: Click on this icon to view and take print of respective Patient’s Progress Notes. It allows User to create My Notes as Blank OR from selected Default Tab Progress Notes template OR attach new Progress Notes from Attach tab. Click print to take a print of the selected Progress Notes.
Provider: This field displays the Patient’s Attending Provider Name.
Date of Injury: This field displays the selected Patient’s Date of Injury details entered in the Case Management popup. If there is no case attached/associated to this encounter then only a hyphen (-) is displayed for indicating the same.
Case: The Case field displays the selected Patient’s Case Number (If a case is associated to that encounter) as a hyperlink. Clicking on this hyperlink invokes the Case Management for
Status: This indicates the various stages of the RFA processing through displaying corresponding statuses. These statuses are updated automatically for an RFA depending upon the RFA response received from Insurance, with the exception of the Close status. Following are the statuses that are displayed as dropdown options in this field:
Note:
Notes icon:
Click on this icon to invoke the RFA Notes popup to add Adhoc RFA header-level notes.
User can simply type in the text area or select any phrase from the Search Phrases icon .
If notes are added in RFA Notes popup, then the Notes icon changes to 
.
Insurance: Select the Insurance name (Primary/Secondary) to which the RFA order is sent from this dropdown list. If the Insurance is EDI enabled, then EDI Enabled is displayed in red and bold font to the right of the Insurance name.
Attachments icon:
This icon is displayed only when an EDI enabled insurance is selected from the Insurance dropdown.
This icon enables a user to attach documents to be sent along with the RFA.
On click, an Attachment popup is displayed.
The user can click on the Docs 
button on this popup to open a Document List popup to select the documents to be attached.
A maximum of 9 documents can be attached from this Attachment popup.
After a document is added from this popup, the Attach icon changes from to 
.
Employer Notes:
Clicking this icon invokes the Notes for <Employer Name> popup.
This popup is a view only popup, hence Users are unable to edit/modify any details.
If the RFA is EDI Enabled, then this icon is displayed after the Attachments icon and before the Patient Details icon.
The Employer Notes are displayed based on the Employer associated with the RFA encounter.
The tooltip of the Employer Notes icon reads Encounter Employer: <Employer Name>.
If no Employer is associated with an encounter, then this icon is disabled.
The tooltip is such cases is displayed as Encounter Employer: None.
If the selected employer doesn’t have notes added in its Employer Master screen, then this icon is disabled.
The tooltip yet displays Encounter Employer: <Employer Name>.
User(s) have the provision to choose the manner in which Orders/Tests are processed from this list/table. They can select to process a single/multiple/all orders depending on their preference. To select required Order simply click on Test Name or select/check the corresponding checkbox at individual order (row) level.
The Order List table consists of following columns:
Type: This column displays the type of the test/order. It displays LB for Lab, RD for Radiology, PR for Procedure, CO for Consult, RX for Prescription and IT for Items/DME).
Note:For the bundled RFA, the column displays Type a blank
as per the property rfa.order.groupbytype.
WCPOR checkbox: This is a test level Request Type checkbox and is displayed only for EDI-enabled Insurances. If the user checks this checkbox and clicks on the eSEND button, then the RFA will have the Written Confirmation of prior oral request checkbox checked. This checkbox remains enabled until the RFA is sent. Once the RFA is sent, this checkbox remains checked and disabled on PreAuth Tracking screen until a response is received. Once the response is received, this checkbox becomes checked and enabled.
RFA Response Status: This column displays the RFA response status of all orders. User can manually change this status in case of a telephonic response from the Insurance Company. On hovering/clicking three dotted vertical button:
following status options are displayed:Reference: This column displays the respective Order Number (Lab/Radiology/Procedure etc.)
Sent Date: This column displays the date when an RFA Response Status is marked as RFA Sent either manually or electronically for the first time. On marking the RFA Response Status to RFA Sent manually, the User must click on the RESET button. The screen loads and the Sent Date value is added under this column.
Notes: The Notes
icon present in this column allows clinic users to add test-specific notes for each order test at row-level.
This column and the icons are displayed only when the admin-level property rfa.show.notes.for.orders is turned On.
A < Test Name > Notes popup is invoked on clicking the Notes icon which has the following elements:
icon changes to icon when notes are added in the < Test Name > Notes popup.
The notes are for clinic users’ reference to enter information regarding the order/test and are not displayed on the individual order screens.
These notes cannot be printed and cannot be sent in the RFA Letter recipient specified in the To field.
Acknowledgment: This column is displayed only when an EDI enabled insurance is selected in the Insurance dropdown on the RHS and is hidden for non- EDI enabled insurances. In this column, an Acknowledgment
icon is displayed for each test/order in the RFA.
This icon is disabled for tests/orders in Unprocessed status as well as for those sent tests for which acknowledgment is not yet received.
The icon becomes enabled and clickable after an acknowledgment is received for a sent RFA.
On click, this icon invokes an Acknowledgment Notes popup which displays acknowledgments received from Insurance.
Del: Clicking on the cross icon for the corresponding RFA order to delete it from the list.
This section is used to draft and send RFA Order letters and view corresponding responses received from the Insurance Companies. Thus, it is aptly further sub-divided into two tabs;
Users can draft letters for requesting authorization for Tests/Orders to Insurance Companies from this section.
On selecting orders (having same status) in the Upper Right Panel and further clicking on RFA Letter button, the default RFA template loads in the Text Editor which contains selected RFA order details (This is based on the RFA Letter template defined in the Letters Master).
Total count of orders (rows) selected from Upper Right Panel is displayed next to Appeal Letter button. For example, (5 Selected). Similarly, if any RFA entry’s Response Status is set as Appeal , then on clicking Appeal Letter button the total count of selected Appeal orders (rows) is displayed next to the button.
To hyperlink: Clicking on this hyperlink, a To – List popup is invoked from which User can select the list of recipients to whom the letter is sent. User has the option of selecting the recipients from existing master list or adding a recipient, which will be added as a new entry under Address Book master. Under the Select Type drop-down of this popup, following options are displayed:
Cc hyperlink: Clicking on this hyperlink, a Cc – List popup is invoked from which User can select the list of recipients to whom the letter is to be CC’d while sending it. User has the option of selecting the recipients from existing master list or adding a recipient, which will be added as a new entry under Address Book master. Under the Select Type drop-down of this popup, following options are displayed:
Subject: Enter the Subject of the letter being sent in this field.
Attach button:
Clicking on this button invokes the Document List for Patient Name popup which allows Users to attach documents to the RFA/Appeal letter being sent.
A maximum of 50 documents can be selected by clicking on the Sel checkbox of this popup.
A More Attachments 
icon is displayed after the eight-document icon present beside the Attach button.
Clicking on this icon invokes the Attachments popup.
On this popup the User can click on the required icon to view the Document or detach the document by clicking on the Detach button.
Based on the value selected in this rfa.attachcenter.search.displaystatus property
from the Properties Master screen, the Attach button under the Response tab is enabled or disabled for the User.
Date: The current (today’s) system date is displayed in the right corner in-line with the recipient’s selection fields (i.e. To and Cc fields).
Maximize : Click on this icon to expand the text editor in an enlarged view. This helps in better viewing and user readability.
RFA Letter: Click on RFA Letter radio button to load the default RFA order letter template in the Text Editor which contains selected RFA order details (This is based on the default RFA Letter template defined in the system). Various tags can be used to print required information in the RFA Letter, some examples of which are given below:
The admin-level properties, dwc25.consult.col.udftags and dwc25.procedure.col.udftags determine what output should be displayed for UDF on Consult or Procedure in which column of DWC25 tag on the RFA or Appeal Letter.
Text Editor: Depending on the button (i.e. RFA Letter or Appeal Letter) that User clicks on, the default template of respective letter is added in this Text Editor. User also has the option of typing the letter content manually in this editor for sending it to the selected recipients. This editor also contains some standard text editing tools which can be useful in drafting respective letter manually.
RESET button: Click to reset any changes made on the screen.
DELETE button: Click on the DELETE button to delete the saved RFA letter/Appeal letter. If the user clicks on the DELETE button a warning message “The selected Response letter will be deleted. Are you sure you want to delete it?" is displayed. The warning message popup has two action buttons:
SAVE button: This button is enabled only on selecting an RFA/Appeal letter template. Click on this button to save the RFA letter/Appeal letter. On click, the screen refreshes and a message "Letter Saved Successfully" is displayed.
Note:
In case of RFA and Appeal, if a letter is already displayed, edited and saved and if a user selects another letter from the template selection dropdown, then the new letter overwrites the previous one although it was saved.
PREVIEW button: For EDI Enabled RFAs, a PREVIEW button is displayed instead of the SAVE button. On clicking on this PREVIEW button, the RFA DWC Interface Form is invoked on this popup along with two action buttons: CLOSE and eSEND. Click on the CLOSE button to close the popup, or click on the eSEND button to send the RFA via EDI.
SEND button: Click this button to send the RFA request/appeal letter. On clicking Send, a Confirm Recipient Details popup is displayed. On this popup, for each recipient there are three options, as per User preference these can be simply clicked and selected to choose the method/mode of sending the RFA/Appeal Letters. Options for Print, Fax and Email are available. Fax Cover Sheet gets displayed on selecting a template in the property, bizfax.RFA.coversheet.template and sending a fax through Fax mechanism from PreAuth Tracking screen. Selected Template can be cleared by clicking on the Clear link. By default, the value in this property is blank.
eSEND button: The label of the SEND button changes to eSEND if the Insurance is an EDI-enabled Insurance. Users can click on this button to send the RFA via EDI. If all required information is present in the system, then a message: EDI Sent Successfully is displayed on eSEND, else a validation message for the missing information is displayed. On eSEND of an RFA, a DWC’s RFA Form in PDF format is generated using the letter template selected in the property rfa.dwcrfaform.edi.template. This generated PDF is sent in the 275 file along with the generated 278 and NCPDP files with Attachment Type set as OD - DWC’s RFA Form. The auto generated RFA Interface Form for each tests can be previewed from the Sent Letters
icon on the Sent Letters popup.
These forms are also added under the patient’s document list on Document List screen with type as RFA Letter and category as RFA Interface DWC Form.
The column labelled as ‘Other Information Freq/Durn/Qty’ under the RFA DWC Interface Form also displays the information added under the Service Quantity, Requested Treatment Occurrence and the Time Period Duration fields of the Frequency/Sessions for <> popup invoked by clicking on the Freq./Sessions icon of the TOC → Consults/Procedure screen. If no details are added in the Frequency/Sessions for <>, popup then the 'Other Information Freq/Durn/Qty' column under the RFA DWC Interface Form remains blank.
Critical information required to send RFAs via EDI:
This tab displays the responses received from the Insurance Companies to whom the RFA/Appeal requests were made. Clicking on the Maximize icon the response attachment is displayed in enlarged view, which helps User in better viewing and readability.
A delete icon is given to delete the attached response with the RFA under the Response tab on the PreAuth Tracking screen. On clicking the icon, a confirmation message gets displayed “Are you sure you want to delete the response”. When the OK button is clicked the response gets deleted and the page gets refreshed, if the Cancel button is clicked then the confirmation message popup gets closed, and the attached response remains attached under the Response tab. The deleted response gets deleted from the Document List screen as well. The detached file gets added and displayed under Detach folder selected from the Select Folder dropdown on the Attach Center screen.