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Prior authorizations are a constant hassle in the world of EMS transport. AngelTrack provides many features for managing prior authorizations, automatically attaching them to matching dispatches.
The problem with prior authorizations is this: EMS is not allowed to file them... yet EMS is required to keep track of them, and submit them back with to the insurance carriers.
Therefore EMS is saddled with all of the responsibility, but none of the power.
AngelTrack provides the tools needed to fulfill this responsibility -- to track all prior authorization numbers [PANs], associate them with matching dispatches, notify customers when PANs are missing, and submit the PANs back to the insurance carriers.
All dispatches that probably need a PAN are listed in the Prior Authorization Queue. You can service that queue in-house or outsource it to an outside biller.
This queue is independent of the normal workflow: a dispatch can appear in this queue at the same time it appears in a workflow queue.
Here is what you'll see in the queue:
Each of the highlighted functions is discussed in detail, further down in this document.
The PCS form is a kind of prior authorization. AngelTrack knows which dispatches require a PCS, and tracks this independent of the need (if any) for a PAN.
However, since it is common to collect both PCS and PAN forms from the same person (the social worker) at the nursing home, the Prior Authorization Queue allows you to see all dispatches where either one is missing. Simply use the filters at the top of the queue to show missing PANs, missing PCS forms, or both:
On the Billing Home page, the link to the Prior Authorization Queue is shown in red whenever its accompanying number is above zero, like this: Prior Auth Queue (4)
That number indicates how many insurable dispatches are in the queue waiting to either receive a PAN or be marked "PAN not necessary". The number is calculated like this:
This list represents all insurable dispatches that still have time to file and obtain a PAN. Of course you can always open the queue and move the date ranges wider.
Some EMS companies simply wash their hands of the problem of PANs... leaving it entirely up to the customer. If the customer gets it done and phones in the authorization number, then great; if not, then not.
AngelTrack supports this approach, hereafter called the "Passive PAN Workflow":
plus sign to add it. It is not necessary to include a page scan, if you don't have one.
That's all you have to do. You can simply ignore the Prior Auth Queue, or just use it to record missing PCS documents.
This workflow is simple and requires little labor. Unfortunately it will tend to maximize your customers' stretcher bills, as many insurable transports are denied for want of a PAN. This will eventually put your facility contracts in jeopardy, as competitors promise to lower your customers' stretcher bills by taking a more active approach to managing their PANs.
For EMS companies who take an active approach to prior authorizations, AngelTrack provides many features to reduce the workload. It is intended to help you follow this workflow, which includes all the steps from the passive PAN workflow described above:
plus sign to add it. It is not necessary to include a page scan, if you don't have one.
button.
This workflow can be performed by one person, or it can be divided up among several people, as you see fit. Dispatches, billers, and captains all have the necessary access in AngelTrack to perform any step of the workflow. Many EMS companies delegate some of the PAN work to their dispatchers, to be handled during the quiet periods.
In addition to the workflow, you must perform two other tasks from time to time:
AngelTrack can quickly record a PAN during call-taking, but can also collect PANs at later dates.
It is super easy to record a PAN given to you during call-taking. The Dispatch Create page has a specific field just for the PAN. If anything is typed into the field, it will be saved as a PAN document type attached to the dispatch -- and hence appearing in both the outbound and return trips. This automatic document has no page scans, and does not need any... but of course you can always add some later.
When a facility communicates that a PAN has been issued, you must then tell AngelTrack that this is so. You can do this with or without having an actual copy of the PAN request form or the issuance document... though best practice is to obtain copies of all such documents, in case you are audited later.
In the Prior Authorization Queue, every waiting dispatch has 
and/or 
buttons you can click to record a document. The buttons appear when AngelTrack believes that the associated document is needed; otherwise, PAN and/or PCS appears, indicating that the relevant document is not needed.
Clicking either plus button will open the Attach Prior Auth to Patient page, with all fields neatly pre-loaded for the respective dispatch. This is very convenient and is a good reason to use the Prior Auth Queue for this task.
You can record the filed request, or you can record the received authorization, either one, or both, it doesn't matter. If you have a copy of the actual document, scan and attach and image of it too; if not, provide a comment containing the authorization number or at least explaining where the original document resides.
Once that's done, the document will automatically appear in every applicable dispatch within the date range you specified; there is no need to record the same document again for the other transports within its validity period. All such dispatches will then disappear from the queue (since they now have the needed document). If the provided document is a PCS, then crews performing those transports will no longer be prompted to collect the PCS while on-scene.
If you have a PAN but the relevant dispatch is not in the Prior Auth Queue, you can record it manually instead. From the Prior Auths On File page available under Billing Home, click the button to open the Attach Prior Auth to Patient form.
AngelTrack will prompt you to attach the records for the patient and for the destination facility. Both of these are required; you cannot attach a PAN to an unnamed patient or to a raw street address. You must also specify the range of approved transport dates.
Once the document is uploaded (with or without page scans), it will automatically appear in every applicable dispatch within the date range you specified. All such dispatches will then disappear from the Prior Auth Queue since they now have the needed document.
If you record a PAN without page scans, and then later obtain the scans, it is easy to add them. The scans will thereafter appear in all applicable run reports.
To do so, find the document in the Prior Auths On File list or using the Librarian, and click the button that appears in the 'Content' column.
If an insurance carrier issues a PAN which authorizes a certain number of trips, rather than a certain expiration date, AngelTrack will automatically manage it for you.
When uploading the trip-counted PAN into AngelTrack, select the ☑ Automatically set the expiration date after _____ trips option, and input the number of authorized trips. AngelTrack will then monitor the document and its attached patient. When the specified number of trips are completed, AngelTrack will automatically set the expiration date, causing the document to be reported as "expired".
PAN and PCS documents are stored in AngelTrack's document system, and are subject to its rules.
PAN and PCS documents will automatically appear in any dispatches that match the following criteria:
Under these rules, multi-day PCS and PAN documents can be uploaded just once, and will thereafter automatically appear in all relevant run reports.
Occasionally an insurer will authorize a PAN for the patient to travel anywhere... yet AngelTrack requires a destination when uploading a PAN. To resolve this, record the PAN's destination as the patient's residence.
By recording the PAN as the patient's residence, it will automatically attach to any dispatches to and from the residence... which will be almost all of the patient's transports. Manual intervention will only be required when the patient takes a three-legged trip, such as from home to doctor to dialysis to home; the PAN must be manually attached to the trip from doctor to dialysis, since neither origin nor destination is the patient's residence.
Individual patient records in AngelTrack can be flagged for unusual PAN requirements:
This is what the three settings do:
button.
button for every one of the patient's dispatches.
The flag is global for the patient (i.e. not checkpointed) and so it instantly affects all of the patient's calls, past and future.
Your contracted facilities can visit the Customer Portal to check whether any PANs are still missing for upcoming calls. Each call shown in the portal will display a "PAN" icon when it requires a PAN and does not yet have one on file.
As shown above, the "PAN" icons become clickable links -- leading to the relevant insurance carrier's online PAN form -- if you input the URLs into AngelTrack's insurance carrier records. Do this using the Insurance Payor IDs List under Billing Home. Once that's done, your nursing homes will be able to easily click to download the correct PAN form for each patient.
AngelTrack's Customer Portal is an excellent way to strengthen your relationship with your facilities' discharge planners / LVNs / social workers, with a view towards hitting 100% PAN placement. At 100% PAN placement, EMS revenue is maximized at the same time as the facility's bill is minimized, because insurance is covering all stretcher calls... and insurance pays higher than most facility contracts.
For further discussion of the PAN problem faced by nursing homes, with insights about nursing home invoices and the protection of your business relationship, read the Understanding Nursing Homes Guide.
Medicare is developing a prior authorization requirement for non-emergency stretcher transports. The program's status page is available on the CMS website here: Prior Authorization of Repetitive Scheduled Non-Emergent Ambulance Transport
The program is slowly rolling out across the country. When the Medicare PAN program comes to your state, AngelTrack is ready. Simply visit the Preferences page under Settings, and tick the ☑ Medicare requires prior authorization for non-emergent transport checkbox. AngelTrack will thereafter assume that all transports covered by Medicare will require a PAN, in the same manner that transports covered by Medicaid are treated.
Affected dispatches will then appear in the Prior Auth Queue in the usual way.
Remember that the Medicare PAN program still requires PCS documents... in fact they are supposed to be submitted along with the PAN request forms. Therefore your billing office or your dispatchers -- whoever is in charge of the Prior Auth Queue -- must be on their game.
So far we have discussed how to track and record your PANs for past and future dispatches. The same tools are also used to track and record your PCS forms.
To learn about the regulations and best practices for PCS forms, read the PCS Requirements Guide. To learn how to visit your customer sites in order to collect many PCS forms at once, read the Bulk PCS Collection Guide.
When your state Medicaid adjuster begins to require a PCS-like certification form for Medicaid-covered transports, AngelTrack will track and manage the certifications for you, the same way it does for PCS forms.
To learn more, read the McPAN Guide.