AUTHORIZATION MANAGEMENT
Authorization Utilization
Utilization provides a live summary of authorized, used, missed, remaining, and utilization percentage values by Individual and service. It helps Provider staff identify capacity, overuse risk, underutilization, expiring authorizations, and records requiring follow-up.
LIVE AUTHORIZATION DATA
Utilization Monitoring
Review authorization consumption without opening each record individually.
Utilization Columns
Individual
Identifies the person whose authorization usage is being reviewed.
Service
Shows the Provider service and billing code connected to the authorization.
Payer
Identifies the payer or funding source responsible for the approved service.
Authorized
Displays the total approved quantity for the authorization period.
Used
Displays qualifying service quantity already consumed.
Missed
Displays missed authorized service quantity when the configured workflow supports it.
Remaining
Shows available units after used and missed values are applied.
Utilization
Shows the percentage of approved capacity already consumed.
How to Interpret Utilization
| Situation | Recommended Review |
|---|---|
| Low Utilization | Confirm whether services have started, whether schedules are accurate, and whether missed or delayed service requires follow-up. |
| Moderate Utilization | Compare the current percentage with the remaining authorization period and expected service frequency. |
| High Utilization | Review remaining capacity, planned schedules, pending visits, and billing activity before additional services are delivered. |
| Zero Remaining | Do not assume further service is billable. Review the payer authorization, service dates, amendments, and Provider policy. |
| Unexpected Used Value | Compare schedule, visit, correction, and billing records and escalate discrepancies to authorized staff. |
| Unexpected Missed Value | Review call-off, canceled shift, incomplete visit, and configured missed-service rules. |
Operational Uses
Confirms that planned services remain within approved capacity.
Supports reconciliation of completed, canceled, missed, or corrected service activity.
Helps prevent billing above the payer-approved limit.
Supports forecasting, renewal preparation, and identification of service-delivery gaps.
Review Checklist
- Confirm the Individual and service are correct.
- Confirm the payer and authorization period.
- Compare used values with completed visits and approved corrections.
- Review missed values only under the Provider’s approved workflow.
- Estimate whether remaining capacity supports the planned service schedule.
- Escalate unexpected values before billing or service expansion.
HIPAA and Proprietary Workflow
Utilization information reveals service participation, payer coverage, and treatment-related activity. Only authorized staff should access or export this information for approved treatment, payment, or health-care-operations purposes.
The public guide does not disclose the complete auto-calculation rules, schedule and visit matching, missed-unit logic, correction precedence, cutover behavior, or billing safeguards. These True Care System workflows are trained directly to official Provider customers.