What is a prior authorization (PA)?
A prior authorization (PA) is approval from an insurance company that allows ABA services to be provided for a specific number of hours or range of dates, and it has to stay current for those services to be covered.
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.