SPF
SPF Revenue Cycle Solutions
STRATEGIZE. PRIORITIZE. FOCUS.
FREE RESOURCE / WORKFLOW CHECKLIST
Prior Authorization Checklist
A step-by-step workflow for submitting, tracking, and managing prior authorizations for behavioral health services — from initial request to approval.
PHASE 1
Verify Eligibility & Authorization Requirements
Verify patient is active and eligible on the date of service
Confirm through payer portal or clearinghouse before requesting auth
REQUIRED
Confirm whether prior authorization is required for planned service
Not all services require auth — verify per payer and service type
REQUIRED
Identify the correct auth request method (online portal, fax, phone)
Each payer uses a different submission method — confirm before submitting
REQUIRED
Confirm number of sessions authorized per approval
Some payers authorize per episode; others per session or per year
RECOMMENDED
Note authorization turnaround time for this payer
Standard: 3–5 business days. Urgent: 24–72 hrs. Schedule accordingly.
TRACK
PHASE 2
Gather Required Documentation
Completed auth request form (payer-specific)
Download current form from payer portal — do not use outdated versions
REQUIRED
DSM-5 / ICD-10 diagnosis code(s)
Primary and secondary diagnoses supporting medical necessity
REQUIRED
Clinical notes / intake assessment supporting medical necessity
Most payers require at minimum an intake or biopsychosocial assessment
REQUIRED
Treatment plan documenting frequency, modality, and goals
Many payers require a signed treatment plan with auth request
DOCUMENT
Provider NPI, taxonomy code, and practice address verified
Mismatched provider info is a leading cause of auth denials
REQUIRED
CPT code(s) and requested number of sessions included
Be specific — vague requests delay approval
REQUIRED
Previous treatment history (if extension or renewal request)
Include progress notes, session count, and response to treatment
DOCUMENT
PHASE 3
Submit the Authorization Request
Submit via payer's preferred method (portal, fax, phone)
Portal submissions typically have the fastest turnaround
REQUIRED
Retain confirmation number or fax confirmation
Save all submission receipts — these are your proof of timely submission
REQUIRED
Log auth request in tracking system with submission date
Every request should be logged with date submitted, payer, CPT, and expected turnaround
TRACK
Set follow-up reminder for 3–5 business days if no response
Don't wait for the payer to notify you — proactively follow up
RECOMMENDED
PHASE 4
Track Status & Follow Up
Check auth status at 3–5 business days if no determination received
Call payer or check portal — do not assume silence means approval
REQUIRED
Document auth number, approval dates, and session count upon approval
Record exact approval details in patient's billing record and EHR
REQUIRED
Communicate approved sessions and dates to treating provider
Provider should not schedule beyond approved sessions without renewal
REQUIRED
Set renewal reminder at 75% of authorized sessions used
Begin renewal process well before sessions are exhausted
TRACK
Monitor auth expiration dates in tracking log
Approvals have expiration dates — sessions used after expiry may not be covered
TRACK
Authorization Tracking Log
| Auth # | Payer | CPT Code | Sessions Approved | Start Date | End Date | Sessions Used | Status |
|---|---|---|---|---|---|---|---|
Common Auth Denial Reasons & How to Respond
Not medically necessary
Submit a peer-to-peer review request. Provide detailed clinical notes supporting medical necessity and diagnosis severity.
Missing or incomplete documentation
Resubmit with complete documentation. Confirm all required attachments with the payer before resubmitting.
Service not covered / out of network
Verify provider participation status. If OON, confirm whether OON benefits apply and document accordingly.
Auth submitted after services rendered
Request retroactive authorization immediately. Most payers allow 30–60 days for retro auth — act fast.
Incorrect member information
Verify member ID, group number, and date of birth. Resubmit with corrected information after confirming eligibility.
Duplicate request
Check payer portal for an existing auth before resubmitting. Contact payer to confirm status of original request.
Authorization management taking too much time?
SPF Revenue Cycle Solutions handles prior auth submission, tracking, and follow-up — so your clinical team can focus on patients, not paperwork.