Overview
When reviewing an authorization, you may notice that an attached document is contains information for a different patient or a different authorization. In this case, you can remove the document and send it back to the fax queue so it can be routed correctly.
Before You Remove a Document: Third-Party Responses
A document from a third-party company does not necessarily mean it was incorrectly associated with your authorization. Several payers use partner companies to manage and review prior authorization requests. You may receive a response from one of these companies on the payer’s behalf.
Common examples include:
- Cohere Health: Provides prior authorization and utilization management services for health plans.
- CVS Caremark: A Pharmacy Benefit Manager (PBM) that handles and evaluates prior authorization requests for many health insurance plans.
Before removing a document, review its patient and authorization details to confirm whether it belongs to your request. Do not remove it solely because the sender’s name differs from the payer’s name.
From the Response Window
Locate the authorization and click Review Response to open it.
Review the attached document. If it is unrelated to the patient or authorization, click Wrong File.
Select the appropriate reason for removal from the options provided, then click Confirm.
The document will be removed from the authorization and returned to the fax queue to be attached to the correct authorization.
From the Activity Screen
Navigate to the Activity screen and locate the authorization with the incorrect document.
A confirmation window will appear. Click Remove to confirm.
The document will be removed from the authorization and returned to the fax queue for correct processing.
The document will be removed from the authorization and returned to the fax queue for correct routing. The authorization’s status will change back to Pending.
Still need help? Contact support: help@samacare.com