Managing prior authorizations

Use Visits → (a visit) → Insurance to check coverage and manage the patient’s scripts and prior authorizations. In the left sidebar, click Visits, click the visit, then click Insurance in the visit section navigation. Authorizations are tracked on the patient, so the same record can appear wherever that patient’s eligibility details are shown.

How do I run an eligibility check for a visit?

In the left sidebar, click Visits, click the visit, then click Insurance in the visit section navigation when you need to confirm the patient’s coverage for that visit. The result can also flag scripts or prior authorizations that are over their visit limit or have visits scheduled after they ended.

1. Find the Eligibility card.
2. Select Check eligibility if no check has been run yet.
3. If a check already exists, select View eligibility details.
4. Select Recheck if you need to run the check again.

After the check runs, the eligibility details show coverage, when the check was run, benefit rows, insurance on file, and the patient’s Scripts & Auths.

How do I add a prior authorization or script?

In the left sidebar, click Visits, click the visit, then click Insurance in the visit section navigation when you need to track a visit allowance for the patient.

1. Select View eligibility details on the Eligibility card.
2. In Scripts & Auths, select Add. If there are no records yet, select No scripts or auths yet — add one.
3. In Type, choose Script or Prior-auth.
4. Enter the Number, if you have one.
5. Fill in Total, Used, Scheduled, Valid from and Valid until as needed.
6. Select Add authorization.

Ona adds the script or prior authorization to the patient and updates the authorization list. The eligibility result may also update because authorization compliance is included in the overall eligibility verdict.

How do I track remaining visits?

In the left sidebar, click Visits, click the visit, then click Insurance in the visit section navigation. Use Scripts & Auths to see whether a patient still has visits available. Ona calculates Remaining visits as Total minus Used minus Scheduled.

Field	What it tracks
Total	The total number of visits allowed by the script or prior authorization.
Used	Visits already used.
Scheduled	Future visits already scheduled against the script or prior authorization.
Remaining visits	The visits left after used and scheduled visits are subtracted.

The count fields accept whole numbers. If the remaining count falls below zero, the remaining visit number is shown in red.

Each authorization card can also show related visits. Upcoming visits are visible first. Past visits are grouped behind a past visits toggle. A visit can be marked Outside dates when it is scheduled after the authorization end date, or Exceeds visits when it is beyond the authorized visit count.

How do I edit a prior authorization or script?

In the left sidebar, click Visits, click the visit, then click Insurance in the visit section navigation when the approved visit count, authorization number or valid date range changes.

1. Select View eligibility details on the Eligibility card.
2. In Scripts & Auths, find the script or prior authorization.
3. Select Edit authorization on its card.
4. Update the Number, visit counts, Valid from or Valid until.
5. Select Save changes.

The authorization is updated on the patient, and the eligibility details refresh. In edit mode, Type is not shown, so you cannot change a saved Script into a Prior-auth or a Prior-auth into a Script here.

What does Auth issue mean?

In the left sidebar, click Visits, click the visit, then click Insurance in the visit section navigation to review an Auth issue. An Auth issue means one or more scripts or prior authorizations need attention. Open the eligibility details to see which record is affected.

The Authorizations warning can show:

Issue	What it means
Over its visit limit	The record is over the allowed visit count.
Visits scheduled after it ended	One or more visits are scheduled after the authorization’s end date.
Over its visit limit and past its end date	Both problems are present.

Select View authorization in the warning to jump to the matching card in Scripts & Auths. Update the visit counts or valid dates if the record is missing the latest payer information.

How do out-of-date authorizations work?

In the left sidebar, click Visits, click the visit, then click Insurance in the visit section navigation. In Scripts & Auths, an authorization becomes out of date after its Valid until date has passed. Out-of-date records move into a collapsed out of date section so active records stay first.

Open the out of date section to review or edit old records. If you update Valid until to a current or future date, the record can appear with the active scripts and authorizations again.

What can't I do here?

In the left sidebar, click Visits, click the visit, then click Insurance in the visit section navigation. Authorization management has these limits:

• You cannot change the Type of an existing record while editing it.
• You cannot delete a script or prior authorization from Scripts & Auths.
• You cannot save decimals or text in Total, Used or Scheduled. These fields accept whole numbers only.
• Ona cannot store the outcome of a phone eligibility check when a payer does not support electronic checks. Record what the payer tells you on the patient’s chart.

Common questions

Is a prior authorization saved to the visit or the patient?

It is tracked on the patient. When you add one from a visit’s eligibility details (in the left sidebar, click Visits, click the visit, then click Insurance in the visit section navigation), Ona saves it to that patient’s Scripts & Auths.

What is the difference between Script and Prior-auth?

Both types use the same number, visit count and valid date fields. Choose the type that matches the record you received.

Why does eligibility show an authorization issue if coverage is eligible?

Eligibility combines payer coverage with authorization compliance. If payer coverage is eligible but a script or prior authorization is over its visit limit or has visits scheduled after it ended, the overall result can show an authorization issue.

What should I do when an eligibility check fails?

In the left sidebar, click Visits, click the visit, then click Insurance in the visit section navigation. Open the eligibility details and read Why the check failed. Fix the insurance details or payer information shown in the message, then select Try again or Recheck. For more detail, see Reading eligibility results.

Where do I update the patient’s insurance details?

In the left sidebar, click Visits, click the visit, then click Insurance in the visit section navigation. Open the Insurance section inside eligibility details, or update the patient’s insurance record. See Patient insurance and card scanning.