Financial Review - Frequently Asked Questions

This quick guide answers frequently asked questions about Financial Review in VieCure, where financial coordinators manage prior authorizations for medications, tests, procedures and other orders. It covers updating authorization status and approval details, what the coverage status badges mean, what to do when an authorization is missing or denied, and checking a patient's insurance.

 How do I approve prior authorization?

Prior authorizations are managed on the Financial Review screen in the patient chart. Users who can view the chart can see the table; only users with Financial Review edit permission can change an authorization.

1. Open Financial Review and find the item (you can filter or sort any column, for example by Status or Order ID).
2. Click the row, or open the ... menu on the row and select Edit Item, to open the Authorization Details modal.
3. Set Status to Approved, enter the Prior Authorization Ref# from the payer, and update the limit information and Authorization Source (Fax, Payer Portal or Phone) as needed.
4. Click Save Changes.

After saving, the item's card and row show the new status and the Remaining progress bar. The Prior Auth Ref# column is blank until an item is approved and stays on the record afterward.

Items start at New and move to Pending once the request has been submitted to the payer. To edit several items at once, tick the row checkboxes and click Edit [#] Items; each item is saved on its own.

 Why is the prior authorization dollar sign red and what do I do about it?

Authorization state is shown by a coverage status badge that always pairs an icon with a text label. Denied and Expired are the two red statuses; Appealed and Expiring are orange; Approved is green; New and Pending are blue; Closed is charcoal.

The same badge also appears on the medication row in the MAR, on the line item in the Flowsheet, on the charge line in Projected Charges and on each medication in Pharmacy Dispensing. Hover over the badge to see "Financial Review". The badge is display-only; open Financial Review to act on it.

• Denied — Follow "A prior authorization was denied (test, procedure or drug) - what are the steps?"
• Expired — The item cannot be reversed. A new authorization record is needed (see "No prior authorization is on file for a treatment - what are the steps?"). Expired authorizations also lock the medication in the MAR.
• Expiring — Plan ahead and submit a new request before it expires.

 No prior authorization is on file for a treatment - what are the steps?

When a plan is started or an order is placed outside a plan, the system checks the patient's active insurance plan. If the billing code needs approval, an authorization item is created automatically with status New and appears in Financial Review. If the patient's insurance is flagged "Pending Configuration", the check cannot run and the item gets a distinct status instead of silently defaulting to "no approval needed".

1. Open Financial Review and filter by Order ID or Item Description to look for an existing item.
2. If none exists and one is needed, click + Prior Authorization (or + Item on a treatment plan header to add it to that plan).
3. Complete the required fields in the Authorization Details modal. Order ID defaults to Draft; choose the patient's real order instead if one exists.
4. Click Save. The item appears as New. Update it to Pending once the request is sent to the payer.
5. Draft items — Choosing Draft creates a scratch record used to test the payer's response. It is not visible outside Financial Review and does not trigger MAR locks.
6. Insurance change — If a patient's insurance changes, existing items are not re-checked automatically. A worklist task is created so the financial team can review which orders need resubmission.
7. Duplicates — A warning and a Duplicate badge appear if the same billing code and date already exist; saving is still allowed.

 A prior authorization was denied (test, procedure or drug) - what are the steps?

When the payer denies an authorization, set the item's Status to Denied in Financial Review. The line moves to the Inactive section, shows a red badge, and the medication is locked in the MAR.

1. Open the item in Financial Review and review the denial details.
2. Decide the next step: appeal, resubmit the same request, or submit a new authorization.
3. To appeal, set Status to Appealed. To resubmit the same record, set Status to Pending. Either moves the item back to the Active section.
4. Or create a new authorization with + Prior Authorization or + Item. The original denied record stays in Inactive.

If an appeal is also denied, the item returns to Denied. There is no limit on appeal cycles. Add notes with the Comments icon on the row.

 Can I tell whether a patient's insurance is valid (or termed) before dispensing drugs?

• Authorization status — The coverage status badge appears on each medication in Pharmacy Dispensing, the MAR and the Flowsheet. An Expired or Denied authorization locks administration in the MAR.
• Insurance changes from the billing system — When your practice management system sends a new or updated insurance plan, the financial team gets a "New Insurance Plan — Coverage & Auth Review" worklist task. It shows the previous and new plan and prompts staff to review authorizations.
• Policy details — Coverage start and end dates appear on a Prior Authorization Request report.