Start an authorization follow-up
prior_authorization_requestWe handle outpatient behavioral health authorizations, for counseling and for ABA, at a flat $39 per authorization: we submit the request to the payer, follow it up until it is approved or denied, and watch the approved units and end date so the next authorization is started before the current one runs out. Send the practice's email and name, the rendering clinician's NPI, the payer (when it has plans in several states or of several kinds, also the member's plan as payer_state, two letters, and plan_type: commercial, medicare_advantage, medicaid, chip, exchange or other), the patient's name, date of birth and member ID, the service type (outpatient_counseling or aba), the service (CPT or HCPCS codes, up to 8; the units or sessions requested with unit_kind; the start date and, optionally, the period as end_date or weeks; for ABA the hours per week and at least one adaptive behavior code, 97151 to 97158, 0362T or 0373T, and with end_date or weeks the units may be left out: they are worked out as hours a week x 4 fifteen-minute units x weeks, and the reply's requested_period says how), the ICD-10 diagnosis codes (up to 12), and whether it is new or a renewal (a renewal or re-authorization adds the current authorization number and the date it expires). A clinical document is a PDF, JPG or PNG up to 3 MB as base64 in a request of at most 4.4 MB, or up to 4 MB as a form upload; it is optional for counseling, and an ABA request goes to the payer only once its treatment plan or assessment is in (send it with the request or later on its page). Paid at checkout before any work starts; nothing is sent to the payer until payment. The reply has the reference, a Stripe checkout link, the requested period as saved (requested_period) and an access token, shown once, that opens the authorization's status. Once approved, the next authorization is prepared 14 days before the approved end date for counseling and 30 days before for ABA, or sooner when the units used say they run out first; a renewal or re-authorization is its own request, at the price of the authorization it follows. Not included: appeals of a denial, peer-to-peer reviews, and billing claims.
Input Schema
| Name | Required | Description | Default |
|---|---|---|---|
| payer | Yes | The payer or health plan, as on the insurance card. | |
| weeks | No | Optional. Or the length in weeks (26 for six months): the end date is worked out from start_date. | |
| end_date | No | Optional. The last day of service requested (YYYY-MM-DD), up to a year after start_date. Send this or weeks. | |
| cpt_codes | Yes | CPT or HCPCS codes, such as 90837, or for ABA 97153 and 97155. | |
| member_id | Yes | As on the insurance card. | |
| plan_type | No | Optional. The kind of plan on the card, when the payer has several (a payer's Medicaid plan can go by a different route than its commercial plans). | |
| unit_kind | No | sessions or units, with units_requested. Worked-out ABA totals are units (15 minutes each). | |
| start_date | Yes | The first day of service, such as 2026-11-03; up to 90 days back or 365 ahead. | |
| patient_dob | Yes | Date of birth, such as 1990-04-15. | |
| payer_state | No | Optional. The state of the member's plan (two letters, such as TX), when the payer has plans in several states. | |
| partner_code | No | Optional. A partner code Licium gave you: your agreed price is charged instead of the list price. A code that is not active is refused and nothing is saved. | |
| patient_name | Yes | The patient's first and last name as on the insurance card. | |
| request_type | Yes | new, or renewal of a current authorization (send its number and expiration). | |
| service_type | Yes | aba: applied behavior analysis (hours per week, adaptive behavior codes, the treatment plan before it goes to the payer). | |
| clinician_npi | Yes | The rendering clinician's 10-digit NPI. | |
| practice_name | Yes | ||
| hours_per_week | No | ABA only: hours per week requested. | |
| practice_email | Yes | The practice's email, where status emails go. | |
| diagnosis_codes | Yes | ICD-10 codes, such as F33.1. | |
| units_requested | No | Units or sessions requested in total, with unit_kind. ABA: leave it out with hours_per_week and end_date or weeks, and Licium works it out (hours a week x 4 fifteen-minute units x weeks; the reply's requested_period says how). | |
| clinical_document_base64 | No | A treatment plan or assessment, base64 encoded: a PDF, JPG or PNG up to 3 MB, in a request of at most 4.4 MB. Optional for counseling; an ABA request goes to the payer once it is in. | |
| existing_authorization_number | No | Renewal only: the current authorization number. | |
| existing_authorization_expires_on | No | Renewal only: the day the current authorization expires. |