What is a prior authorization (PA)?

Most payers require an ABA provider to obtain authorization before therapy begins, and again each time it is renewed. The authorization spells out what has been approved - typically which services, how many units or hours, and the date range they can be delivered in.

Providers have to monitor authorizations as they are used. If sessions run past the approved end date or exceed the approved units, the claims for those sessions are usually denied even though the work was delivered.

Renewals generally depend on clinical documentation - most often a progress report showing what the client has achieved and why continued services are recommended - which is why authorization tracking and clinical reporting tend to be managed side by side.

An authorization is usually more specific than a single number of hours. It commonly breaks approved units out by service - assessment, direct therapy, protocol modification, caregiver guidance - and a practice can exhaust one category while another still has room. Tracking a single aggregate total is a frequent way teams end up delivering work that turns out not to be covered.

The renewal calendar is what practices most often get caught by. Payers need the reauthorization request and supporting documentation well before the current period ends, and a report that arrives late can leave a gap where sessions are still being delivered against an expired authorization. Teams generally work backwards from the end date, scheduling the progress report and the request with enough lead time to absorb a request for more information.

Not every service requires prior authorization with every payer, and requirements change as contracts are renegotiated. Because of that, the safest habit is verifying requirements at intake and again at each renewal rather than assuming last year's rules still hold - and keeping the authorization record close enough to scheduling that a session cannot quietly be booked outside it.