Revenue
Authorization Tracking
Authorization Tracking is Coralia's payer prior-authorization module for ABA (Applied Behavior Analysis) agencies: every authorization becomes a per-client, per-CPT-code (Current Procedural Terminology) unit ledger where booking a session reserves units, approving it consumes them, and cancelling releases them. Health scores, pacing verdicts, expiration and appeal-deadline alerts, and coverage-gap recovery are computed on top of that ledger.
The problem in real agencies
Every hour of ABA therapy runs on a payer prior authorization: a fixed grant of units per CPT code, valid for a date window, per client, per payer. A mid-sized agency juggles dozens of these at once, each with its own end date, unit ceilings, and reauthorization paperwork. Most agencies track them in spreadsheets that drift from reality the moment a session is canceled, rescheduled, or delivered long.
The drift has a price. A session delivered after the units ran out, or after the end date passed, is unbillable work an RBT (Registered Behavior Technician) already performed. A reauthorization submitted late forces a coverage gap in which a BCBA (Board Certified Behavior Analyst) must choose between interrupting a child's therapy and delivering care nobody pays for. A denial letter whose appeal-filing deadline nobody put on a calendar quietly becomes forfeited revenue.
The people spending the units usually cannot see them. Scheduling and clinical decisions consume authorization units, but the ledger — where money and remaining balance live — sits with billing. So schedulers book blind, therapists under-deliver against approved hours without knowing it, and the first anyone hears of an exhausted authorization is a rejected claim.
How it works in Coralia
- 1
Transcribe the payer's grant into a live unit ledger
Staff enter an authorization in one step: authorization number, start and end dates, payer, place of service, ICD-10 (International Classification of Diseases) diagnosis codes, and inline CPT service lines. Each line carries three counters — approved, used (delivered), and reserved (scheduled but not yet delivered) — so available units are always approved minus used minus reserved. The system blocks date-overlapping periods for the same client and payer (canceled, denied, and under-appeal periods never block a fresh grant) and links each renewal to the authorization it replaces.
- 2
Booking reserves units; approval consumes them
When a session is booked, Coralia validates coverage against the ledger — suggesting the soonest-expiring matching unit line first — and reserves units on that CPT line. Per-code weekly and monthly caps, when an agency sets them below the period total, and a client-global hours ceiling (for example, a 40-hour weekly state Medicaid limit) are enforced at booking time. Approving the delivered session converts reserved units to used; a cancellation or no-show releases the reservation. A nightly job reconciles the counters against actual linked sessions, so the ledger heals itself instead of drifting.
- 3
Monitor the whole portfolio in the Authorization Command Center
A dedicated dashboard with four tabs — Portfolio, Financial, Reauthorization, and Coverage Gaps — scores every authorization 0–100 (utilization risk weighted 40%, pacing 30%, expiry 30%) into green, amber, and red tiers, with an honest caveat when reserved-but-undelivered units are what lift the score. Pacing analysis projects a burn rate and exhaustion date and states the consequence plainly: on track, burning fast, runs out early, out of units, underusing, or far underusing. Revenue-at-risk totals expiring-unused and underutilized units in booked dollars without double-counting, and an unscheduled-demand panel ranks authorized-but-unbooked value by dollars at risk.
- 4
Run reauthorizations and appeals on clocks, not memory
A derived tracker classifies every expiring authorization as on track, action needed, submission overdue, or coverage gap imminent, using renewal lineage and active reassessments. Expiration alerts fire at 60, 30, 14, and 7 days; inside the 30-day band with nothing submitted, an overdue alert fires, and Coralia automatically queues an insurance-eligibility recheck through the Claim.MD clearinghouse. Recording a denial stamps an appeal-deadline clock from the payer's appeal-filing window, with alerts at 14, 7, and 3 days; denials with no known deadline are flagged for a human to enter the letter's date.
- 5
Never block care during a gap — recover the billing later
When a payer grants fewer units than requested, the cut is snapshotted per service line, already-scheduled work above the granted ceiling raises an over-committed warning, and a biller can file a reduction appeal — an overturned outcome restores the units — while care continues on the granted amount. Sessions worked during an authorization gap are flagged at-risk, never blocked or auto-canceled: clinical judgment decides whether the child is seen. When a covering authorization is approved, a biller retro-links the gap sessions in one click, and they consume units through the normal ledger path and become billable.
- 6
Give clinical staff the units, not the money
RBTs and BCBAs see a read-only My Caseload page: each assigned client's current authorizations, remaining units, and expiration dates — deliberately no rates, claims, or dollar figures. A weekly caseload-burn widget shows delivered, scheduled, and open units against the week's pace, with a behind, on-pace, or complete status, streaks, and chips flagging shared clients, payer caps, and expiring authorizations. The people whose scheduling decisions actually spend the units can finally see the balance — without gaining access to the money side of the practice.
The specifics
Nine authorization statuses with an enforced transition machine — a denied authorization can never move straight to approved — an overturned denial reaches it through an appeal.
Health scores run 0–100, weighting utilization risk 40%, pacing risk 30%, and expiry risk 30%, tiered green (71+), amber (41–70), and red (40 or below).
Six pacing verdicts named by consequence: out of units, runs out early, burning fast, on track, underusing, and far underusing.
Expiration alerts at 60/30/14/7 days, appeal-deadline alerts at 14/7/3 days, and a weekday agency digest containing no protected health information — counts and payer aggregates only.
Four scheduled background jobs: daily auto-expiry (valid through the whole last calendar day in the agency's timezone), nightly ledger reconciliation, weekday expiration reminders, and a weekly burn-rate monitor.
A fully consumed authorization flips to exhausted with a critical alert, and reactivates automatically when capacity returns — units added or a void freeing them.
A built-in Florida Medicaid Behavior Analysis fee schedule (23 CPT code-plus-modifier entries, effective January 2025, plus three universal multi-family group entries) is overridable per payer and per authorization line.
A reauthorization is a brand-new period with a fresh unit ledger, linked to its predecessor explicitly or inferred within a 180-day same-client, same-payer window.
Assessment code 97151 can bill retroactively against an expired period when the service date fell inside the authorized window; every other code needs an unexpired approval.
Every authorization keeps an append-style event history — created, status changed, expired, exhausted, renewal linked, appeals filed and resolved — recording who acted and whether the actor was a user or the system.
Integrations
Claim.MD clearinghouse — an authorization within 30 days of expiry automatically triggers an insurance-eligibility recheck for that client · Billing & Revenue Cycle — the unit ledger gates session approval and claim generation; only approved, unexpired coverage bills · Scheduling & Calendar — session and calendar dialogs live-validate coverage against the ledger and reserve units at booking · Assessments & Progress Reports — active reassessments count as a renewal in flight, and agencies can require a current signed progress report before a reauthorization is sent
Access control
Financial surfaces — the Command Center views, revenue-at-risk, pacing, history, and the coverage-gap retro-link — are gated by billing permissions, and filing or resolving a reduction appeal requires a dedicated appeal permission on top of client-edit rights. Clinical staff reach My Caseload and the weekly burn view through a separate caseload permission that carries no billing access.
Frequently asked questions
What happens if a session is delivered during an authorization gap?
Nothing blocks it — Coralia never auto-cancels or blocks clinical work over a lapsed authorization. The session is flagged at-risk (billable code, no authorization link) and appears in the Coverage Gaps tab. When a covering authorization is approved, a biller retro-links the gap sessions in one click; they consume units through the normal ledger and become billable retroactively.
Can we schedule sessions before the payer sends the authorization number?
Yes. A pending authorization allows scheduling — the calendar keeps flowing — but never billing: session approval and claim generation gate on approved status. When the payer approves, every session already linked to that authorization becomes billable automatically, with no relinking. Appealed and pended authorizations follow the same schedulable-but-not-billable rule.
How does Coralia handle a partial approval, where the payer grants fewer units than requested?
The requested-versus-granted cut is snapshotted per service line and drives a step-down indicator. If already-scheduled work exceeds the new ceiling, an over-committed warning fires. A biller with the appeal permission can file a reduction appeal; if it is overturned, the units are restored to the ledger. Care continues on the granted units the whole time.
How do the unit counters stay accurate when sessions change?
Through lifecycle plus reconciliation. Booking a session reserves units, approving it converts reserved to used, and canceling or marking a no-show releases the reservation — available units are always approved minus used minus reserved. Every night a background job recomputes the counters from the actual linked sessions and heals any drift, so the number on screen matches what was really delivered.
Do RBTs and BCBAs see billing rates or claims?
No. Clinical staff use a read-only My Caseload page showing their assigned clients' authorizations, remaining units, and expiration dates — no rates, claims, or dollar amounts — plus a weekly caseload-burn widget tracking delivered and scheduled units against pace. Both are gated by a clinical caseload permission separate from billing permissions. You can explore both views in the live demo at coralia.app/demo, a full synthetic agency with no sign-up.