Authorization Auto Link Logic
When Authorization auto link is enabled, OfficeEMR automatically links an existing authorization to an appointment or claim based on the logic below. See Authorization Setup.
An authorization must be Active to be eligible for auto-linking (see the definition at the end of this section).
Appointment Auto-Link
| Condition | Result |
|---|---|
| An active authorization exists for the primary payer on the appointment | Link the authorization to the appointment |
| Multiple active authorizations exist for the primary payer | Do not link |
| The authorization specifies a rendering provider and it matches the appointment's resource | Link the authorization |
| The authorization specifies a rendering provider and it does not match the appointment's resource | Do not link |
Claim Auto-Link (Primary, Secondary, and Tertiary Payer)
Claims are evaluated independently for the primary, secondary, and tertiary payer. For the primary payer, this check runs only if an authorization was not already linked from the appointment.
| Condition | Result |
|---|---|
| An active authorization exists for the payer level on the claim | Link the authorization, subject to the procedure and rendering provider checks below |
| The authorization specifies a procedure and that procedure is on the claim | Link the authorization |
| The authorization specifies a procedure and that procedure is not on the claim | Do not link |
| The authorization specifies a rendering provider and that provider is on the claim | Link the authorization |
| The authorization specifies a rendering provider and that provider is not on the claim | Do not link |
| Multiple active authorizations exist for the payer level and at least one has a matching procedure code | Link based on the procedure code match |
| Multiple active authorizations exist for the payer level and none has a matching procedure code | Do not link |
| Multiple active authorizations exist for the payer level and at least one has a matching rendering provider | Link based on the rendering provider match |
| Multiple active authorizations exist for the payer level and none has a matching rendering provider | Do not link |
Authorization "Active" Definition
An authorization must be Active — based on its effective dates and remaining visit count — to be eligible for auto-linking.
| Criteria | Requirement |
|---|---|
| Effective Dates | The appointment date (or claim date of service) must fall between the authorization's start and end date |
| Visit Counts | Visits utilized must be less than the total number of authorized visits |
