Service Unit Authorization Report

The Service Unit Authorization report in NextGen® Enterprise PM enables you to review and monitor patients with service unit authorizations to determine whether they have met or exceeded the maximum number of packaged services authorized by their insurance, and whether those services were provided within the time frame authorized by the payer. You can also use the report to determine if patients with upcoming appointments are nearing their service limit so an authorization for additional units or days can be requested and obtained from their insurance.

This encounter-based report is available only if a Service Package Library is selected in Practice Preferences > Libraries.

For more information on Service Packages and Service Unit Authorization, go to the NextGen Healthcare Success Community and download the Behavioral Health Billing User Guide for NextGen® Enterprise PM

The Service Unit Authorization report includes patients with a service unit authorization that have encounters with charges matching one of the service configurations within their authorized service package. The service configuration defines specific CPT4 code and modifier combinations with a service maximum in units or hours and a service duration in days.

The report uses the following calculation to show whether a patient has met or exceeded the service maximum number of service units authorized by their insurance:

Package Service Limit - Service Units Used = Service Units Remaining

You can filter the report using an Encounter Date or an Appointment Date range and either include or exclude pending charges from NextGen® Enterprise EHR that have not yet been processed in NextGen® Enterprise PM. You can also filter the report to include or exclude package, encounter and appointment data.

The report has "drill-down" functionality that enables you to double-click an encounter to access the Patient Chart > Encounters tab directly from the report. From the encounter, you can then access the Charge Posting window to view charges on the encounter. Drill-down is not available for service package configurations on the report that do not have an associated encounter with charges for services in the configuration.

To access the report in NextGen® Enterprise PM, select the Reports menu and select General, then select Authorizations, and then select Service Unit Authorization.