How to Fix 7 Common Prior Authorization Errors in ABA Therapy

For ABA providers, getting prior authorization (PA) right isn’t just another administrative checkbox—it’s a critical step that directly impacts therapy continuity, cash flow, and your ability to serve clients on time. A single delay in the PA process can stall services, leave claims unpaid, and add stress to both therapists and families.

In the day-to-day operations of ABA billing services, few tasks are as complex—and as easy to trip over—as prior authorization. Surveys show it's one of the top frustrations among therapy providers, mainly because the rules keep changing and mistakes are so costly.

In this article, we’ll walk through seven common prior authorization errors in ABA billing services and show you practical ways to avoid them.

Incomplete or Inaccurate Documentation

A common pitfall in ABA billing is submitting incomplete or incorrect documentation. Just one missing CPT code, signature, or updated evaluation can trigger a claim denial instantly. Accuracy truly matters when every detail counts.

Documentation errors account for more than 10% of all claim rejections, as noted by PraxisNotes. In many cases, the required information is either out-of-date or improperly formatted, leading to processing delays or flat-out rejections.

✅ How to Fix It

• Standardize Documentation Protocols: Use a comprehensive checklist for every submission. Ensure required documents—such as signed treatment plans, updated assessments, and session data—are always included.

• Monthly Documentation Audits: Take time each month to review a random set of prior authorizations—it's one of the easiest ways to catch repeat mistakes early.

• Train Both Clinical and Billing Staff: Provide regular cross-functional training to ensure both teams understand payer documentation standards.

• Utilize ABA Billing Software: Tools like CentralReach, TherapyPM, or Catalyst can enforce compliance through built-in documentation requirements.

📊 More than 1 in 10 claims get denied simply because of documentation mistakes—proof that even small errors can impact your ABA billing process.

Submitting Requests Too Late

Submitting an authorization after services have already started—or just days before—is a recipe for trouble. Payers often need several days, if not weeks, to process these requests. If they’re late, it could mean therapy has to pause or payment is denied.

✅ How to Fix It

• Create an Internal Timeline: Build a schedule that gets submissions in well before payers’ deadlines.

• Set Reminders: Automate alerts inside your ABA billing software so no one misses key dates.

• Plan Ahead for Renewals: If therapy is expected to continue, start the reauthorization process at least a month in advance.

📊 Patients typically wait more than 7 days for urgent authorizations—delays cost care and cash.

Misunderstanding Insurance Requirements

Each payer plays by a different rulebook. What works for one might be flatly denied by another. For practices working with multiple insurance plans, it’s easy to get tripped up by small variations in what’s required.

More than half of ABA providers run into denials because they aren’t updated with the latest payer rules.

✅ How to Fix It

• Keep a Living Payer Guide: Document what each insurance company requires and update it regularly.

• Assign Ownership: Have one person on your team responsible for monitoring payer changes.

• Distribute Updates Quickly: Use a shared dashboard, internal emails, or team huddles to share any new updates.

📊 55% of providers struggle with inconsistent payer guidelines.

Poor Communication Between Providers and Payers

Sometimes the issue isn’t what you submit—it’s what you don’t follow up on. Prior authorizations often get denied or stalled simply because no one responded to a clarification request or sent additional information.

✅ How to Fix It

• Designate a Contact Per Payer: Assign a team member or department to be the go-to for each insurance company.

• Use Secure Messaging Tools: Platforms like Spruce or direct insurer portals help ensure clear, HIPAA-compliant communication.

• Respond Quickly: Set a rule to answer any payer requests within 24 business hours to keep things moving.

📊 A lot of avoidable denials in ABA billing happen just because of missed follow-ups or poor communication between providers and insurance teams.

Forgetting to Monitor Authorization Expirations

One of the most avoidable issues in ABA therapy billing is letting an authorization expire. Providers often discover it only after submitting a claim, resulting in denied payment for completed services.

✅ How to Fix It

• Use Tracking Tools: Rely on dashboards or spreadsheets that highlight upcoming expiration dates.

• Set Alerts 30 Days in Advance: Build reminders into your calendar or software system.

• Hold Weekly Renewal Checks: Review which PAs are nearing expiration and assign follow-up responsibility.

📊 Expired authorizations are one of the top reasons claims are denied in ABA billing services.

Poor Justification of Medical Necessity

Insurance companies want to see more than just a diagnosis—they expect a clear, well-documented reason why ABA therapy is essential for this specific client. Vague goals or recycled language won’t cut it.

✅ How to Fix It

• Align Goals with Assessments: Every goal should connect directly to a specific behavior or assessment outcome.

• Use Clear, Measurable Language: Avoid generic descriptions. Be specific about the child’s challenges and how therapy addresses them.

• Provide Training: Train BCBAs to explain medical necessity clearly, aligning documentation with payer guidelines and current ABA billing updates to reduce denials and improve approvals.

No Clear Appeals Process for Denials

Even when you do everything right, some prior authorization will still be denied. That’s where a strong appeal process matters. Unfortunately, ABA practices simply give up on denials because they don’t have a plan—or the time—to fight back.

Yet, most denied claims are recoverable, according to TherapyPM.

✅ How to Fix It:

• Create Templates for Appeals: Save time by building appeal letter templates that staff can personalize quickly.

• Track Each Appeal: Use ABA billing company to track submission dates, responses, and outcomes.

• Assign a Follow-Up Owner: Each appeal should have a team member who follows it through to resolution.

📊 Denied doesn’t mean dead. Most claims can be recovered—if you act fast and with the right documentation.

FAQ

1.How do you handle authorization denial?

Review the denial reason, correct any issues, gather strong documentation, submit an appeal quickly, and track progress to ensure timely resolution and payment.

2.How do prior authorization errors impact an ABA practice?

Mistakes cause claim denials, delayed payments, interrupted care, and extra admin work—hurting your revenue and making it harder to support clients consistently.

3.Why does prior authorization matter in ABA practices?

It helps avoid denials, speeds up payments, and keeps your billing cycle steady—so your team can focus more on delivering care.

Conclusion

Prior authorization may always be part of the ABA billing landscape, but it doesn’t have to be such a headache. When you focus on precision, proactive tracking, and smart workflows, you can dramatically reduce denials—and spend less time chasing paperwork.

Fixing these seven common errors is about more than protecting revenue. It’s about keeping therapy consistent, clients supported, and your practice running smoothly. With the right tools, team, and training, ABA billing services can run like a well-oiled machine—even when payers make it tough.