Correcting an Unauthorized Service Exception

Unauthorized service exceptions are triggered through the Sandata system when the payer, program, or service details entered in the system by the provider don’t match the recipient’s visit record. When a mismatch is identified, providers’ alerts are triggered, and a red dot will appear on the visit and under the Exceptions tab.

To correct the record, providers should first compare the visit against the recipient's authorization and identify any discrepancies. If no discrepancy is found, please contact the Electronic Visit Verification (EVV) Provider Hotline at 855-805-3505 for assistance.

This video provides an overview of common errors that cause the unauthorized service exception in the visit maintenance module and provides some guidance on ways to resolve this exception.

When a mismatch is found, follow these steps to correct the error.

1. Once logged into the Sandata EVV system, view Visit Details for comparison against the Recipient authorization:

        a. In Visit Maintenance, a red dot will appear under the Service column if there is a discrepancy.

        b. Select the red dot in the service column.  

        c. Take note of the Payer, Program, and Service on the General tab. You will need this information to compare with the authorization.

2. View the Recipient Authorization for comparison against the visit details.

        a. Select Recipients, then select Recipient Management. Under Recipient Management, use the quick search to find the Recipient record. When the record displays, select the Status to open the record.

        b. Select the Program tab.

        c. The Authorization Details section is found in the bottom right corner of the screen.

        d. If an authorization is present, the details will appear.

        e. If the system does not have an active authorization for the recipient, it displays only the ADD AUTHORIZATION button and an authorization will need to be added. 

3. To view voided and expired authorizations, the Voided Auth. and Expired Auth. buttons must be selected. Make sure the toggle is to the left with a white background and no checkmark to view active Authorizations.

   

        a. Voided Auth. – If a provider receives information from the payer that the authorization does not meet the criteria for approval and should be voided, the provider has the option to void the authorization in EVV, still being able to keep a record in the system.

        b. Expired Auth. – If the current date is passed the authorization End Date, the authorization can be marked expired.

The table below highlights potential mismatch scenarios that may cause an Unauthorized Service exceptions, and the actions needed to correct them.

Scenario	Action Needed	Next Steps/Notes
There is no authorization.	Create an authorization.	Remember to add the correct start date if the visit took place in the past. The dates need to match.
The authorization details are correct.	Compare the visit payer, program, and service listed in the Recipient record with the authorization details	Review the steps for Creating a New Recipient to make sure the correct payer, program, and service are on the Recipient record.
The authorization was entered with the incorrect expiration date.	Find the expired authorization for the Recipient and correct the End Date.	For more details, review the steps for Creating an Authorization.
The authorization expired.	Create a new authorization.	Remember to add the correct start date if the visit took place in the past. The dates need to match.
The authorization details match.	Contact the EVV Provider Hotline at 855-805-3505.