Authorization Setup controls how OfficeEMR validates, warns on, and calculates insurance authorizations across appointments, claims, and the patient chart. These settings determine whether an authorization is required before a visit is scheduled, checked in, or billed, and how the system warns staff when one is missing, expiring, or out of visits/units.
Where to find it: From the Billing portal, open Insurance > Authorizations (Beta), then click the gear icon in the upper right corner of the Authorization Search screen. This opens the Authorization Rules window, which is organized into five rule categories:
- Payer Authorization Rules
- Appointment Authorization Rules
- Insurance Authorization Rules
- Authorization Warning Rules
- Authorization Calculations Rules
Payer Authorization Rules
- Check if [level] payer set to required — when enabled, the system checks whether the payer on this insurance level is flagged as requiring authorization, and validates accordingly.
- [Level] payer always required — when enabled, an authorization is always required for this insurance level, regardless of the payer's individual setting.
Appointment Authorization Rules
Purpose: Appointment Authorization Rules control when the system checks for a valid authorization during the appointment lifecycle, and whether the Authorization window automatically opens when a check comes back negative.
- Authorization Appointment Auto Load
- Auto load authorization window on negative check — automatically opens the Authorization window if the check fails.
- Authorization Appointment Status
- Appointment Scheduled — checks for a valid authorization when the appointment is scheduled.
- Appointment No-Show — checks for a valid authorization when the appointment is marked as a no-show.
- Appointment Checked-In — checks for a valid authorization when the patient is checked in.
- Appointment Checked-Out — checks for a valid authorization when the patient is checked out.
- Appointment Confirmed — checks for a valid authorization when the appointment is confirmed.
- Appointment Cancelled — checks for a valid authorization when the appointment is cancelled.
- Any other appointment status — extends the check to appointment statuses not otherwise listed.
Insurance Authorization Rules
Purpose: Insurance Authorization Rules control whether the system checks for a required authorization at the insurance level, independent of appointment or payer-specific rules.
Groups and Settings: Check if insurance set to required — when enabled, the system checks whether the insurance on file is flagged as requiring an authorization.
Authorization Warning Rules
Purpose: Authorization Warning Rules control when and where staff are warned about expiring authorizations; when working in the scheduler, during claim save, or when opening the patient chart.
Groups and Settings:
- Miscellaneous
- Any other appointment status — extends the warning to appointment statuses not otherwise covered.
- Authorization Appointment Status
- Appointment Scheduled / No-Show / Checked-In / Checked-Out / Confirmed / Cancelled — the same six appointment-status triggers used in Appointment Authorization Rules, but raising a warning rather than a hard validation.
- Authorization Claim Save
- Claim Save — if enabled, authorization warnings pop up when a claim is saved.
- Electronic Superbill Save — if enabled, authorization warnings pop up when an electronic superbill is saved.
- Authorization Patient
- Display Patient Authorization Warning — if enabled, authorization warnings pop up when the patient window opens.
- Display Scheduler Authorization Warning — if enabled, authorization warnings pop up when a patient is selected within the iScheduler.
Authorization Calculations Rules
Purpose: Authorization Calculations Rules control whether the system calculates authorization usage (visits/units remaining), and whether appointments and claims are automatically linked to an existing authorization.
Groups and Settings:
- Authorization calculations — when enabled, turns on system calculation of remaining authorization visits, units, or dollar amounts.
- Authorization auto link — when enabled, appointments and claims are automatically linked to a matching authorization on file. See Authorization Auto Link Logic.
