Authorization Management Is Revenue Cycle Management
Authorization denials are one of the top causes of ABA revenue loss. A structured authorization management process reduces claim denials, improves cash flow, and ensures continuous care for patients.
Before Requesting an Authorization
- Verify current eligibility and benefits — confirm ABA is covered and what the annual/per-service limits are
- Confirm the correct payer and plan (patients may have changed jobs/plans)
- Determine whether a physician referral is required prior to the BCBA assessment
- Gather the required clinical documentation (assessment, BIP, diagnosis records)
Submitting the Authorization Request
- Submit before services begin — retroactive authorization requests are often denied or require extra work
- Submit via the payer portal when possible for faster processing and digital confirmation
- Request the right codes (97151 for assessment, 97153 for direct therapy, etc.) with the correct number of units
- Keep a copy of the submission confirmation
What to Track for Each Authorization
- Authorization number
- Authorized CPT codes and units
- Effective dates (start and end)
- Rendering provider(s) approved
- Approved location/setting
- Units used vs. units remaining
- Re-authorization due date (typically 30–60 days before expiry)
Re-Authorization Checklist
- Start the re-auth process at least 30 days before current auth expires
- Prepare updated assessment data and progress notes
- If the patient has made significant progress, adjust the hours requested accordingly with clinical justification
- Submit re-auth request to payer
- Follow up every 5–7 business days if no response
- Document all payer contacts with dates and representative names
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