They’ve sent the request back. They want another authorization signed.
We’ve all been there. The facility or copy service doesn’t think the insurance company’s blanket authorization is sufficient. So, what are they looking for on the authorizations?
As time goes on, we see facilities and copy services becoming more and more stringent with their internal requirements for authorizations. The issue is what is written on the authorizations, how it’s written and how it relates to their requirements. Below is a list of standard requirements for authorizations:
Standard Requirements for Authorizations:
- Patient Identification
- Purpose of disclosure
- Statement of Individual’s right to revoke the authorization and how to revoke it
- Statement that health information provided may be subject to re-disclosure and no longer protected by privacy rules after re-disclosure
- Conditioning statement
- Signature of patient or representative
- Date signed
- Expiration date
- Statement that specially protected health information may be disclosed, specifically Mental Health, HIV/AIDS, and Alcohol/Substance abuse records. (May only be required if included in the records, each facility is different)
Most generic authorizations will include these items. Most small physician’s offices find this acceptable. However, when we get into health systems, hospitals and copy services, they tend to require additional items on the authorizations. Below are some examples:
Examples of Generic Authorizations
- Who specifically can release the information: They require full facility name and address on the actual authorization.
- Who specifically are records to be released to: They require full name, address and phone number of the company receiving the information on the actual authorization.
- Meaningful and specific description of information to be released: This information would include specific dates of service and the specific types of records (Discharge Summary, Progress Notes, Operative Reports, etc…) a facility will require on the actual authorization.
- Specific patient identifiers may be required on the authorization, such as birthdate or social security number.
How can a generic authorization be designed to comply with requirements, limiting the number of additional authorizations that will need to be completed by Insured or family members? Ensure that all the information in the first set of bullet points is on the authorization. There are additional items beyond these that can be helpful.
- We have a client that includes a boxed area at the top of their generic authorizations where the signor can write the name and address of facilities where records are known to be located. This generic authorization is often accepted where others are denied as it then gives specific permission to those facilities to release records.
- The full date of birth of the Insured is the most requested patient identifier to be specifically listed on an authorization. Including it on your generic authorizations may help speed the process along.
- Any other specifics your company is comfortable including will only help speed the process.
How can RSB assist?
- We have a database with which we are keeping track of the facilities specific requirements as they are expressed. This helps to speed processing as we may know going in if the generic authorization is acceptable to the source, or if we should get another signed.
- Some facilities require additional documentation, particularly for death claims. This is also being tracked.
- RSB has a generic authorization that was designed with an attorney to meet all state requirements across the board. All pertinent patient identifiers are included as well as a place to add specific facility information. While it is accepted by almost all facilities, we recommend using facility-specific authorizations wherever possible in California.
Denial of authorizations and requests for additional documents are a huge contributing factor to lengthy processing times for records. Please contact us with any questions related to authorizations or ways in which we can help.
-Misty Gethers, Supervisor/Retrieval Specialist RSB