Max visit limit countdown feature request:
• We have two major payers that have calendar year visit max and require authorization after x amount of visits. Ex. 20 visit limit with precert required after the 5th visit.
• There is currently do not have a way to monitor the total visit count for the patient/case because the authorization section must be used for the precert field.
o If you must obtain multiple authoriztions for a case, you will only see the current authorization count in the alert fields, not the total visits used.
o You can record the visit max in the insurance section, but there is not a notification of the max being used.
• Another issue that has come up with the autorzaiton field is that once you meet the total authorized limit, the counter does not continue to go up if visits have been exceeded.
o This is an issue because of what I mentioned before about the not having a way to monitor the total visit count (outside of the authorztion).
o The only way I have found the total visit count is to manually count the signed visits. This is not an acceptable way to monitor total visit count for a particular timeframe.
o The case has the signed visit count noted, this is not always appropriate to use as a total visit count for the case. If the case started in 2021, the visit count will not be accurate for the current calendar year.
o Ultimately, a visit max is different than an authorization. Visit max means you can’t get approval for more visits. Authorization means you are eligible for more visits if they are approved. These situations require different ways of tracking to have a clear understanding of the insurance benefits.
