Understanding the Authorization Usage Report in Case Manager

Filters include People Groups, Multi-Select Consumer List, Funding Source, Billing Code and the As Of Date. You may also select whether you want to display usage details by selecting Yes on the Expand All box. If you choose not to expand, you may still click on the plus sign next to the Consumer name and drill down to detail as desired.

Each column is summarized below:

  1. Consumer Name (Last, First Middle Initial)
  2. Authorization Start Date
  3. Authorization Stop Date
  4. Number of months in authorization (Authorization Stop Date – Authorization Start Date)
  5. Used months in Authorization (X. XX) (Last day of month prior to As of Date – Authorization Start Date) Display as X.XX months
  6. Remaining months in Authorization (X. XX) (Authorization Start date – Last day of month prior to As Of date) Display as X.XX months
  7. Monthly average units to use
    1. Determine number of units remaining as of the 1st of the month for the report’s as of date. Example: if report is run as of 10/4/2017 the report will display the number of units remaining as of 1st of the month would be 10/01/2017.
    2. The used units include all service records with a date through the 1st of the month.
    3. The used units are divided by the remaining months in Authorization.
  8. Used units in the As Of month
  9. Remaining units in the As of Month = Monthly average hours/units to use – Used hours/units in the As Of month.
  10. Authorized units
  11. Invoiced units – based on all Invoiced records
  12. Pending units – Based on the records currently in pending status
  13. Remaining units = Authorized – Invoiced – Pending
  14. Hours not included = Unmatched + unapproved + unsigned records that are monthly roll-up. Based on all records currently in Vertex Case Manager and Intuition.

Each billing code/consumer combination can be expanded to view:

  • Used units (invoiced and pending) for the billing code/consumer combination
  • Monthly totals of service units used
  • Group the monthly totals by Provider
  • Show the summary number, not the individual records.
  • Hours not included
  • Monthly total of hours in Unsigned, Unapproved, Unmatched status for the consumer. This is not filtered by the Billing Code
  • Group the month totals by Provider. Use the Provider on the service delivery record
  • Show the summary number, not the individual records.

Expand the consumer record to show:

  • Month
  • Provider Name (Last, First) – Any provider who provided services with the Billing Code to the consumer and those services were billed.
  • Total number of units, or fractional units, provided by each Service Provider. (Units based on Invoiced + Pending).
  1. Determine whether the Invoice Units or Pending Units are based on Hours, Units or Mileage. Each Invoice or Pending line uses one of these three to calculate billable units.
  2. Determine the number of Hours, Units or Mileage on each provider Service Records that make up the Invoice or Pending line
  3. Calculate the % of Hours, Units or Mileage for each provider.
  4. Calculate the unit, or fractional unit, for each provider by ? Invoice or Pending Units % for each provider.
  5. Each provider displays a single total unit for the month

 authorization usage report

 

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