Prior Authorization

When using Zaya’s eligibility and prior authorization process, please follow these guidelines:

• If you already have an Auth #, enter the Auth # on the CMS-1500 form before uploading the claim to the Zaya portal.
• If you do not have an Auth #, our eligibility team will return what the patient’s eligibility and benefit coverage states regarding authorization requirements. However, we cannot see whether you’ve already obtained an authorization on your end. If you have not, please provide the required information for authorization as listed in the portal.

Through Zaya, you can submit the information required for prior authorization to all payers. The Zaya team will use this information to obtain prior authorization and will update you with the outcome.

Submit authorization information for a new patient

1. Navigate to the Prior Authorization page on the portal. If, during the eligibility check, the patient is determined to be Zaya billable and prior authorization is required, the patient will be listed under the Pending tab on the Prior Authorization page.

2. Press 'Submit Information' to begin completing the patient's form. Use the 'Continue' and 'Back' buttons to navigate through the form.

3. In the final step, Attestation and Completion, you must attest to submit the form to Zaya.

If additional information is required to complete your authorization, our Support team will contact you directly.

View authorization outcomes

The Zaya team will submit the patient’s information for authorization within 24-48 business hours. Once the authorization outcome has been received from the payer, the patient will be moved from 'Submitted' to either 'Approved' or 'Denied.'

• Approved: The patient has been approved by the payer. Here, you will find the date the authorization was approved, the authorization number, the approved date range, and the approved visits/units.
• Denied: The patient has been denied by the payer. Here, you will find the date the authorization was denied.

Resubmit information to obtain reauthorization

To reobtain authorization, navigate to the ‘Approved’ tab. To ensure continuous care for your patient, it’s important to reobtain authorization before the approved date range ends or the approved visits/units are used up, whichever occurs first. Avoid waiting until the last minute to request renewals to prevent disruptions in patient care. Your EHR might track expiration dates automatically.