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How to avoid common Authorization Manager musculoskeletal errors
April 30, 2024

This article is for providers who use Authorization Manager to submit requests for musculoskeletal services

Thank you for using Authorization Manager to submit your requests for musculoskeletal services!

After reviewing your submissions over time, we’ve compiled some of the most common errors below, with tips on how to avoid them. We hope this information helps to improve the accuracy of your requests, minimizes pended cases that require manual review, and allows for an overall more efficient process for you.

Common errors How to avoid making mistakes

Selecting the patient’s age

If the patient is 18 years or older, choose the top option:

 

If the patient is under 18 years old, choose the bottom option:

 

Note: Some procedures, such as knee replacements, are not appropriate for patients under 18. If you select the incorrect age, your request may pend for manual review.

Selecting number of symptoms

If the patient has two or more symptoms based on their clinical documentation, then select at least two symptoms from the list when prompted.


If you don’t select at least two symptoms when the patient does have them, your request will pend for manual review.

Selecting unilateral versus bilateral knee replacements

If the patient will have one knee replaced, then select “Yes” when asked if a unilateral knee replacement is planned.


Choosing “No” implies that the surgical plan is to perform bilateral knee replacements (both knees replaced during the same surgery).

Selecting a Medicare subset for Medicare Advantage

For Medicare Advantage members, you must select a Medicare subset when applicable, followed by a Jurisdiction. For Massachusetts, the appropriate Jurisdiction is National Government Services (NGS).


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