Authorizations & Payor Management answers the question: Are we at risk of losing revenue or services?
Proactive authorization management prevents service interruptions and protects your revenue stream. This section helps you monitor expiring authorizations, identify services at risk of non-reimbursement, and track how quickly you're moving clients from assessment to approved treatment.
Table of Contents:
- Which authorizations are expiring in the next 30/60/90 days?
- How many services are being delivered without approved authorization?
- What is the average time to obtain initial assessment authorizations?
Which authorizations are expiring in the next 30/60/90 days?
Proactively tracking authorization expiration dates prevents service interruptions and ensures you have sufficient time to submit renewal requests before coverage lapses. Monitoring authorizations at 30, 60, and 90-day intervals allows you to prioritize renewals based on urgency, accommodate varying payer processing times, and avoid the compliance and revenue risks of delivering services without valid authorization.
Reports Used: Authorizations report >Pending/Ending/Expiring Auths
Helpful Filters:
- Click on the Detail visual
- Use “To date” filter.
- Set to “Advanced filtering” > “Relative date” > “Is in the next” > enter the time frame (e.g., 30/60/90) > Apply filter
- Save as a bookmark for quick access in the future
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How many services are being delivered without approved authorization?
Delivering services without approved authorization creates significant financial and compliance risk, as payers will likely deny reimbursement for unauthorized services. This metric helps you identify workflow breakdowns between authorization management and scheduling, prevent revenue loss from uncompensated care, and ensure you're not accumulating services that may need to be written off or billed directly to families.
Reports Used: Authorizations report >Pending/Ending/Expiring Auths
Helpful Filters:
- Set your date range
- The # of “Schedule Only” authorizations are showing in the # Pending Auths tile in the top left corner
How to Read the Report:
- In the Detail visual, click on the Pending column header to sort the specific authorizations
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What is the average time to obtain initial assessment authorizations?
The time to obtain initial assessment authorizations directly impacts how quickly you can convert new referrals into active clients and begin delivering care. Long authorization timelines can result in families seeking services elsewhere, create bottlenecks in your intake pipeline, and delay the start of billable treatment services, making this a critical metric for both growth and client satisfaction.
Reports Used: Intake report > Pipeline LTs
Helpful Filters:
- Set date range (use all time for best data)
How to Read the Report:
- View the number of days between Assessment Auth Req > Assessment Authorized (this is the median number of days across all clients within the time frame selected)
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