How to Use Service Authorization Requests Feature in eClinicalWorks Software?9 min read

Typically, insurance companies process non-urgent prior authorization requests within 5 to 7 business days after receiving all necessary information. However, when healthcare providers handle these requests manually while managing their clinical responsibilities, the process becomes even more time-consuming and hectic. On average, each physician manages 45 prior authorizations per week, spending nearly 14 hours (or two full business days) on paperwork instead of focusing on patient care. These delays not only disrupt workflows but also lead to revenue losses, denied claims, and frustrated patients.

To eliminate these inefficiencies, eClinicalWorks Software introduces the Service Authorization Requests feature. This powerful tool automates the entire prior authorization process while allowing providers to electronically submit, track, and manage approvals in real time without any paperwork. Integrated with tools like TriZetto Provider Solutions®, Surescripts’ CompletEPA®, and more, it eliminates phone calls, reduces errors, and ensures faster approvals, helping clinics improve efficiency, reduce administrative burden, and focus on what truly matters, which is delivering quality care. This guide will thoroughly explain to you what the Service Authorization Request feature is and how to use it to request prior authorizations without any administrative efforts.                                                                                                                                                               

What Is the Service Authorization Request Feature in eClinicalWorks Software?

A Service Authorization Request feature in eClinicalWorks Software is a platform for healthcare providers to ask an insurance company for permission before performing certain medical services. Some treatments, tests, and procedures require approval so that insurance companies can confirm they are medically necessary, and they will pay for them.

Without prior authorization, a claim may be denied, meaning the provider does not get paid, and the patient might have to cover the full cost. This can cause frustration for everyone involved. The eClinicalWorks software now allows providers to send these requests electronically, saving time and reducing errors.

How Service Authorization Requests Work in eClinical EMR?

The Service Authorization Requests feature in eClinicalWorks EHR makes the approval process much easier. Instead of calling or faxing the insurance company, providers can send requests directly through the eCW system. This functionality of eClinicalWorks Software automates the process for receiving prior insurance company approvals with less delay and administrative burden. It functions electronically by submitting, tracking, and managing authorization requests via TriZetto Provider Solutions®.

Step-by-Step Process

1. Identify Services Requiring Authorization

• eClinicalWorks EMR checks immediately to see if permission is needed based on the patient’s insurance plan when a provider books a treatment, test, or surgery.
• The eClinicalWorks software will ask the provider to start a Service Authorization Request if permission is needed.

2. Submit the Authorization Request Electronically

• The provider fills out the request form directly within eClinicalWorks Software, ensuring all required information is included.
• The request is then electronically submitted to the payer through TriZetto Provider Solutions®, eliminating the need for manual phone calls or faxing paperwork.

3. Track the Request Status in Real-Time

• Providers can monitor the authorization request through the Authorization Tracker in eClinicalWorks EHR.
• The request will show one of the following statuses in eclinical software:

i. Pending: The request has been sent to the payer and is under review.

ii. Approved: The request has been authorized, and an approval code is provided.

iii. Denied: The request was rejected, with a reason given by the payer.

iv. Additional Information Required: The payer needs more details before making a decision.

4. Receive and Store the Authorization Code

• If approved, the authorization code is automatically stored in the patient’s record
• This code is then included in the claim submission, ensuring proper reimbursement and reducing claim denials

5. Manage Denied or Pending Requests

• If a request is denied, providers can review the denial reason, submit corrections, and resubmit the request through eClinicalWorks Software.
• For pending requests showing in eCW health portal, providers can follow up with the payer directly from the system or upload any additional required documents.

This feature is part of eCW medical billing, helping clinics avoid missing authorizations and reducing the number of denied claims.

How to Use Service Authorization Requests in eClinicalWorks EMR?

Using TriZetto Provider Solutions for Authorization Requests

• Open eClinicalWorks EHR and navigate to the Billing Module.
• Select the patient’s record and confirm the service requiring authorization.
• Click on Submit Authorization Request and choose TriZetto Provider Solutions® as the submission method.
• The system will validate the request and automatically send it to the payer.
• Monitor the request status within the eCW medical software’s Authorization Dashboard to check for approvals or required additional documentation.

This integration streamlines the approval process and ensures claims are submitted correctly. Using this feature is simple, and with practice, clinics can save hours of work. Below is a step-by-step guide to help staff members use Service Authorization Requests effectively.

Step 1: Check If Prior Authorization Is Needed

• When scheduling a procedure or service, the system will automatically check if the insurance company requires authorization.
• If it does, a Service Authorization Request needs to be sent before performing the service.

Step 2: Enter Patient and Insurance Details

• In eClinicalWorks Software, open the patient’s record.
• Go to the Billing or Insurance section and enter the necessary insurance details.
• Make sure the patient’s insurance information is up to date.

Step 3: Submit the Request

• Click on the Service Authorization Request option in eCW software.
• Select the procedure or service requiring approval in eclinical works emr.
• Submit the request electronically through TriZetto Provider Solutions®.

Step 4: Track the Status

• Once submitted, the provider can check the status of the request at any time
• If additional information is needed, the system will notify the provider
• If the request is approved, an authorization code will be provided

Step 5: Add the Authorization Code to the Claim

• When submitting a claim to the insurance company, include the authorization code
• This ensures the claim is processed correctly and payment is received

By following these steps, clinics can complete the prior authorization process quickly and reduce the risk of denied claims through eClinicalWorks software’s request authorization feature.

Benefits of Using Service Authorization Requests in eCW EHR

Adding Service Authorization Requests to eClinicalWorks software brings many advantages to clinics and hospitals. Here are some of the biggest benefits:

1. Saves Time

• No need to call or fax insurance companies.
• Requests are sent electronically, reducing processing time.

2. Reduces Errors

• The eCW system automatically checks if authorization is needed.
• Avoids human mistakes that can lead to denied claims.

3. Improves Billing Accuracy

• Helps ensure that providers get paid for the services they perform.
• Authorization codes are stored in patient records for easy claim submission.

4. Enhances Patient Care

• Patients get faster approvals for necessary treatments
• Providers can focus on patient care instead of paperwork

5. Increases Revenue for Clinics

• Fewer denied claims mean more payments are processed successfully.
• Clinics can reduce financial losses caused by missing authorizations.

With these benefits, eCW EMR makes it easier for healthcare providers to manage prior authorizations efficiently.

Common Issues in eCW Authorization and Solutions 

While Service Authorization Requests make the approval process easier, some challenges may still arise. Here are a few common problems and how to solve them within eClinicalWorks software:

Problem 1: Request Takes Too Long

Solution: Check if all patient and insurance details are correct before submitting the request. Sometimes, missing information can delay approval.

Problem 2: Request Is Denied

Solution: If a request is denied, review the reason given by the insurance company. It may need additional documentation or a different diagnosis code.

Problem 3: The System Does Not Show an Authorization Requirement

Solution: Contact the insurance company to confirm if authorization is needed. If required, update the eClinicalWorks system to reflect this.

By understanding these issues and their solutions, providers can make the most of this feature and save hours and dollars both at the same time.

Final Thoughts

eClinicalWorks software’s Service Authorization Requests is a big step up in medical billing and insurance approval. With automation of the prior authorization process, hospitals and clinics are able to save time, cut down on errors, and provide better care for patients.

Follow the above mentioned simple step-by-step process to send, track, and handle permission requests quickly. You won’t have to call anyone or deal with a lot of papers. It speeds up reviews and checks that claims are correct, which is good for both the healthcare provider and the customer.  This tool is something you should think about if your office uses eClinicalWorks EMR. It can help you get paid faster, have fewer billing problems, and run your business more efficiently. Start using Service Authorization Requests today and see how it can make a difference in your clinic! But if you still find requesting authorization difficult and documentation tires you, hire prior authorization professionals like those at Transcure. 

Frequently Asked Questions (FAQs)