Eligilbity: Hospital-CCS, Insurance, prior authorization status
This article details how to locate prior authorization information through the guarantor's insurance coverage, specifically using CCS (California Children's Services) eligibility. It explains how hospitals can check the status of prior authorizations without needing to access the CCS portal directly. The process involves verifying eligibility and tracking the approval or denial status through alternative methods, streamlining the process for those involved in patient care and insurance management.
To access the required information for the patient, follow these steps:
Go to the Guarantor Account: Locate the guarantor account in your system.
Click on "Go To" Tab
Select "Referral Lookup":
Find the First Date of Service: Once in the referral lookup section, locate the first date of service when the patient was seen.
Scroll to "Notes" Section: Scroll down to the "Notes" section, where the Patient Advocate should have all relevant prior authorization information.
Check Prior Authorization Details: The notes will indicate whether prior authorization was needed from the insurance or if the patient has CCS (California Children's Services) eligibility. This is critical to prevent any denials related to coordination of benefits.
Handle Pending CCS Status: If the CCS eligibility is still pending, click on the next referral ID and revise the Patient Advocate notes to update the status and prevent any issues with authorization.
By following these steps, you will ensure that all prior authorization information is documented accurately to avoid potential claim denials.
