Adding and Managing Authorizations

To create a new authorization, navigate to the client's profile and select the Authorizations tab. Click "Add Authorization" to open the authorization form. The first fields to complete are the payer name, which should match the payer record in your billing system, and the authorization number provided by the insurance company. Double-check the authorization number against the payer's approval letter, as even a single digit error will cause claim denials.

Next, enter the effective date range. The start date is when the authorization begins and the end date is when it expires. Some payers issue authorizations for 6 months while others use 3-month or 12-month periods. The date range determines which sessions can be billed against this authorization and when the renewal process needs to begin.

Finally, select the referring provider or diagnosing clinician associated with the authorization. Many payers require this information on claims, and PracticeABA will automatically populate it on claims generated against this authorization. If the referring provider is not already in your system, you can add them from the authorization form without leaving the page.

After the header information is saved, you add the authorized service lines. Click "Add Service Line" and select the CPT code from the dropdown. PracticeABA includes all common ABA service codes including 97151 (assessment), 97152 (assessment follow-up), 97153 (adaptive behavior treatment), 97155 (adaptive behavior treatment with protocol modification), and 97156 (caregiver training). Select the code that matches the payer's approval.

For each service line, enter the approved quantity and the unit of measure. If the payer approves in units where one unit equals 15 minutes, enter the total number of units. If the payer approves in hours, enter the hours and PracticeABA will convert to units for internal tracking. Some payers approve a total for the entire authorization period, while others specify a per-week or per-month limit. Select the appropriate frequency from the dropdown so the system can track utilization correctly.

You can add multiple service lines to a single authorization. Most ABA authorizations include at least two service codes: one for direct therapy and one for supervision. Enter each line separately with its own approved quantity. The authorization summary view will show all lines together with their individual and combined utilization, giving you a complete picture of the client's authorized services.

Authorization modifications occur when a payer approves changes to an existing authorization. Common modifications include increasing or decreasing approved units, adding a new service code, extending the date range, or changing the rendering provider requirements. PracticeABA tracks modifications as updates to the existing authorization record rather than creating a new record, preserving the continuity of utilization tracking.

To record a modification, open the authorization and click "Record Modification." Update the affected fields, such as increasing the units for 97153 from 160 to 200 hours. Add a note explaining the modification, such as "Payer approved additional hours per clinical justification submitted 3/1/2026." Save the modification, and PracticeABA recalculates the remaining balance to reflect the new approved total.

The modification history is displayed on the authorization detail page as a timeline showing each change with its date, the fields affected, and the user who made the update. This history is invaluable during audits when you need to demonstrate that changes to the authorization record correspond to actual payer approvals. Attach the modification approval letter to the authorization record to complete the documentation trail.

Clean authorization data is the foundation of accurate billing. Establish a standard operating procedure for authorization entry that includes a verification step where a second team member reviews the entered data against the payer's approval letter before the authorization is activated. This dual-review process catches typos and misinterpretations that a single data entry person might miss.

Regularly reconcile your authorization records with the payer's records. Some payers provide online portals where you can verify authorization details. Make it a monthly practice to log into each major payer's portal and compare the authorization data in PracticeABA with what the payer has on file. Discrepancies should be investigated and resolved immediately.

PracticeABA includes a data quality indicator on each authorization record that checks for common issues such as missing authorization numbers, expired date ranges with remaining unused units, and service codes that do not match the client's treatment plan. Address any flagged issues promptly. A clean authorization record not only supports accurate billing but also gives your clinical team confidence that they are scheduling services the client is actually authorized to receive.