Service Authorization 'Maximum Unit Override' logic will now be applied per frequency and date range.
There are limited system edits to prevent the user from entering too many MO, DY, HR, WK, or YR units for the Service Authorization date range. When the limit is exceeded for any frequency, a prompt is displayed asking the user if they wish to exceed the limit. If they select 'YES' the Maximum Unit Override will display (the assumption is that a policy exception has been authorized). As long as the unit number exceeds the limit, the Override will display. If units are reduced to a number that no longer exceeds the limit, the Override will not display.
Claims logic will use the same logic as Service Authorization to determine whether billed units for the billing date range can be approved. Claims will determine whether the maximum was exceeded in Units and Rates for the date period encompassing the billing dates. If the maximum was exceeded in Units and Rates, the Claim Item can be approved. However, if the maximum was not exceeded in Units and Rates, the Claim Item will suspend.
See Also
(12-2015)