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Adding an Authorization

Overview

Authorizations track the services, units, and date ranges a funder has approved for an Individual, so that service delivery and billing stay within what has been authorized. Accurate authorizations are the backbone of compliant Medicaid waiver billing — claims for services beyond an authorization's units or outside its date range are at risk of denial or recoupment during an audit. The Add Authorization screen is where staff record those funder approvals, linking them to the correct department, funding source, and service so that downstream scheduling, documentation, and billing all reference the same source of truth.

What is an Authorization?

All users

An Authorization is a record of a funder's approval for a specific service to be delivered to an Individual within a defined date range and unit limit. Authorizations live on the Individual's profile under the Authorizations tab and are the foundation for service tracking and billing in SETWorks.

ℹ️ Terminology can be modified within SETWorks to better fit the needs of your organization. If the terminology in our articles is not the same as what you see on your site, talk to your local administrator to assist in translation.

How to Access, Add, or Modify an Authorization

Accessing Authorizations

Open the Individual's profile and click Authorizations in the left-side navigation menu. The tab displays all existing authorizations for the Individual.

Adding an Authorization

Click the + Add Authorization button near the top of the Authorizations tab. The Add Authorization window will open. Complete the required fields and click Confirm to save.

Modifying an Authorization

Click the name of an existing authorization in the list to open it, then edit the fields as needed and save your changes.

Authorization Information

The Add Authorization window is divided into three field groups — General Fields, Service Fields, and Files — along with a Status section and three sub-sections: Frequencies, Exceptions, and Sub Authorizations.

General Fields

  • Department (required): The department responsible for delivering this service. Selecting a department may filter available services and funding sources and determines how the authorization appears in reporting.
  • Vendor Number: The vendor number associated with this authorization, if provided by the funder. Leave blank if not applicable.
  • Start Date (required): The first date on which services may be delivered under this authorization.
  • End Date: The last date on which services may be delivered under this authorization. Leave blank if the authorization is open-ended; confirm your organization's policy on whether an end date is always required.
  • End Effective Date: The date the authorization is no longer effective for billing purposes. This may differ from the End Date if the funder specifies a separate billing cutoff.
  • Received Date: The date your organization received the authorization from the funder. Tracking this date supports audit readiness and helps staff verify timely processing.
  • Funding Source Contracts (required): The funding source contract associated with this authorization. Select the appropriate contract from the dropdown; this links the authorization to the correct funder for billing.
  • Funding Source Contacts: The specific contact at the funding source associated with this authorization, if applicable.
  • Opr Provider: The operating provider delivering services under this authorization, if different from the default. Select from the dropdown.
  • Previously Used Units: The number of units already used prior to entering this authorization in SETWorks — for example, when an authorization is entered mid-period. Defaults to 0.000.
  • Service (required): The specific service being authorized. Select from the dropdown; available services may be filtered by the Department selected.
  • Authorization Code: The authorization code or number assigned by the funder. This field may default in from the Service configuration. If no code is provided by the funder, leave the default or enter a value that will be useful for staff reference.
  • Rate: The reimbursement rate per unit or hour for this authorization. Defaults to 0. Enter the rate as specified by the funder.
  • Authorized Units (required): The total number of units (hours or visits, depending on the service) approved by the funder for this authorization period. Defaults to 0.000.
  • Service Instructions: Any funder or internal instructions specific to delivering this service under this authorization.
  • Notes: Free-text field for any additional notes relevant to this authorization.
  • Expected Reimbursement (Rate x Units/Hours): Read-only calculated field. Displays the product of the Rate and Authorized Units. Updates automatically as those fields are completed.
  • Hours/Units Count Up: Usage accumulates upward from zero toward the authorized total. This is the default selection and the standard tracking method.
  • No Hours/Unit Tracking: Usage is not tracked against this authorization.
  • Hours/Units Count Down: Usage decrements downward from the authorized total toward zero.
  • Upload a File: Attach supporting documentation — such as the funder's written authorization letter — directly to the authorization record. Click + Add Files to browse and upload.
  • Authorization Status (required): The current status of the authorization. Defaults to In Progress. Update this field as the authorization moves through your organization's workflow. Available statuses may vary by organization configuration.
  • Hours / Units: The number of hours or units allowed within the frequency period.
  • Frequency: The recurrence interval (e.g., weekly, monthly).
  • Date Mode: How the frequency dates are calculated.
  • Dates: The specific date range the frequency rule applies to.
  • Start Date: The beginning of the exception period.
  • End Date: The end of the exception period.
  • Additional Hours: The number of additional hours or units approved for the exception period.

                      Service Fields

                                    Utilization Type

                                    Controls how unit usage is tracked against this authorization.

                                          Files

                                            Status

                                              Frequencies

                                              The Frequencies section defines how authorized units are distributed across a recurring period — for example, 10 hours per week. Click + Add Frequency to add a frequency rule. Each frequency record includes:

                                                      Note: Frequencies are optional. If a funder provides only a total authorized amount without a recurring breakdown, you may leave this section empty and rely solely on the Authorized Units field.

                                                      Exceptions

                                                      The Exceptions section allows you to record approved deviations from the standard frequency — for example, additional units granted for a specific week due to a holiday or service interruption. Click + Add Exception to add an exception record. Each record includes:

                                                            Sub Authorizations

                                                            The Sub Authorizations section allows you to attach child authorizations beneath the primary authorization. Click + Add Authorization within this section to create a sub authorization. Sub authorization records display the following columns in the table: Service, Auth Code, Start Date, End Date, Mode, Frequency, Utilization, Contract, Contact(s), and Status.

                                                            Note: Sub Authorizations are typically used when a parent authorization covers multiple services or components that each require their own unit tracking or billing codes.

                                                            Frequently Asked Questions

                                                            What fields are required to save an authorization?

                                                            The required fields are Department, Service, Start Date, Funding Source Contracts, Authorized Units, and Authorization Status (all marked with an asterisk). The window will not save until all required fields are completed.

                                                            What is the difference between End Date and End Effective Date?

                                                            End Date is the last date services may be delivered under the authorization. End Effective Date is the date the authorization is no longer effective for billing. Some funders specify these separately — for example, services stop on the End Date but claims may still be submitted for a period after. If your funder does not distinguish between the two, entering only the End Date is typically sufficient.

                                                            What does Utilization Type control?

                                                            Utilization Type determines how SETWorks counts units against the authorization. Hours/Units Count Up is the standard setting — usage accumulates toward the authorized total. Hours/Units Count Down decrements from the total. No Hours/Unit Tracking disables unit tracking for this authorization entirely.

                                                            Can I attach the funder's authorization letter to the record?

                                                            Yes. Use the + Add Files button in the Files section to upload supporting documents directly to the authorization record. Storing approval documentation here supports audit readiness and keeps relevant files in one place.

                                                            Can I add an authorization mid-period if some units have already been used?

                                                            Yes. Enter the number of units already delivered in the Previously Used Units field so that SETWorks tracks remaining units accurately from the point of entry forward.

                                                            Why can't I see certain services or funding sources in the dropdowns?

                                                            Available services and funding sources are filtered based on your organization's configuration and the Department selected. If an expected option is missing, confirm the correct department is selected or contact your SETWorks administrator to verify the service and funding source are active and properly configured.