How to Survive an ABA Re-Auth Without It Taking Over Your Life
I'm Cheryl Martin, BCBA, founder of Behavior4Hope ABA. A BCBA on Reddit asked a question I hear all the time: "How am I going to survive a re-auth?". Others in that thread talked about partial denials — asking for 20 hours and getting 15 back. If reauthorizations are swallowing your week, you're not alone.
What follows is general guidance from my experience coaching BCBAs and owners through this. Organized around commonly requested payer documentation elements. Payer requirements vary, and authorization is not guaranteed. Always check your payer's current requirements.
Why re-auths pile up on the same week
When a BCBA tells me a re-auth is eating their whole week, the problem usually started earlier than they think. It isn't only the report itself. It's often that they have more than eight to ten cases on their caseload, and the authorizations are all coming due at the same exact time.
Think about startup. If you take on six to eight kids at the same time, every six months you get that exact number of re-auths landing together. That's a calendar problem, not a character problem.
Two things help upstream:
- Alternate start timeframes when kids begin services, so the six-month clocks don't all ring on the same Monday.
- Switch kids with other BCBAs on the caseload when you need to — just so four re-auths don't land on one person in the same week.
I know swapping cases takes coordination. But if the only goal of a swap is to spread the re-auth load, that alone can keep one BCBA from drowning.
Use a deadline checklist so the report isn't built from scratch
Once a re-auth is coming up, don't wait until the last week. Have a checklist with deadlines. Set it up as an automatic template in Google Sheets or Excel: as soon as you enter the re-auth expiration date, it tells you what to have done at each mark.
A simple timeline has five checkpoints, counted back from the expiration date:
- Two months ahead: schedule the reassessment
- 45 days ahead: send caregiver measures
- 30 days ahead: assessment done
- Three weeks ahead: submit
- One week ahead: confirm the payer received it / follow up
That structure is what keeps the report from being built from scratch at the end.
And start the reassessment earlier than you might think. Many payers don't publish a rule that limits the reassessment to the last 30 days, and some allow that work as early as about 60 days before the authorization expires. I send caregiver measures around 45 days out, so families have about a week to respond, and I have the assessment done by about 30 days out. Submission windows are a different clock: some payers want the request in no later than 30 days before expiration (for those, move your dates a week or two earlier), and others accept it only between 30 days and 2 weeks before. Some payers also limit how old the assessment data can be (for some, within 30 days of the request), so don't start too early either. Check your payer's current rules and set your dates to match.
But here's the hard truth: sometimes this isn't a matter of organization and discipline. Sometimes you have too many kids on your caseload, or too many kids due at the same exact time. That's when you need to talk with your supervisor about making other plans, because these re-auths do take mega time. A prettier spreadsheet will not fix an overloaded caseload.
Avoiding partial denials: match goals to the hours you request
When payers come back with a partial denial — for example, 15 hours approved instead of 20 — it's usually about the number of goals and targets you put in. When the number of goals and targets doesn't support the hours you're asking for, that can invite a partial denial.
What I tell BCBAs as a practice heuristic—not a payer rule: increase your targets so there is roughly one goal for each hour you're asking. Payer requirements vary; always check yours.
Again, this is guidance, not a guarantee. Payers differ. Check what yours requires.
What reviewers keep flagging
Reviewers keep flagging not enough detail, especially medical necessity that isn't broken down clearly. One way I organize it—reflecting autism's core domains, not a required payer template—is communication deficits, social deficits, and other deficits, each explained clearly. Payer forms and labels vary; match what yours asks for. Reviewers also flag transition and discharge plans that aren't detailed enough. Transition and discharge planning should be individualized and present from the start of care, then updated as the learner progresses—not invented at re-auth. Thin detail invites questions; it does not mean a payer automatically cuts hours.
And the goals have to have social significance. You can do that in one of two ways:
- Put the social significance right in the goal itself — for example (hypothetical learner, not a real client): A learner will do A, B, and C with 80% accuracy across 3 of 5 sessions, and this will help the learner (state the specific social significance here).
- Or, right underneath the goal in your treatment plan, have a separate block labeled Social significance.
Either way works. The point is that the "why this matters for this learner" is visible, not assumed.
For clinical directors and owners: stop the fire drill company-wide
If you're a clinical director or owner, put this in place across the company so re-auths stop being a fire drill.
In my experience, I recommend that BCBAs aim for about 28 to 30 billable hours per week—this is my professional opinion, not a regulatory limit or a universal standard. Caseload guidance varies by treatment intensity and supervision model. It's when BCBAs get up to 32 hours per week that the load gets hard to sustain. At that intensity, I also suggest they not have more than about eight kids—but it shouldn't be based on kids alone. Match the workload to how many total hours each child has per week—how many total hours the BCBA is supervising per week.
One BCBA could have eight kids who are all full-time. Another could have four full-time and four part-time. Those are not the same job. The second caseload is a very different stress and burden. Measure by supervised hours, not by the number of names on a list.
Frequently asked questions
Why do all my re-auths hit in the same week?
Often because several kids started around the same time. At six months, those clocks ring together. Stagger start dates when you can, and consider swapping cases with other BCBAs so four re-auths don't land on one person at once.
What should I do month by month before a re-auth is due?
Use a checklist tied to the expiration date: two months (schedule the reassessment), 45 days (send caregiver measures), 30 days (assessment done), 3 weeks (submit), and 1 week (confirm the payer received it / follow up). Enter the date once in a spreadsheet and let it fill the deadlines. If you're still drowning, talk to your supervisor — it may be a caseload problem, not a discipline problem.
What usually invites a partial denial on hours?
Not enough goals and targets to support the hours you're asking for. As a practice heuristic (not a payer rule), I recommend increasing targets so there is roughly one goal for each hour you're asking. Always verify against your payer's current requirements.
What do reviewers want to see that BCBAs often skip?
Clear medical necessity broken into communication, social, and other deficits; a detailed transition and discharge plan; and social significance either inside each goal or in a separate block under it.
Want help thinking this through?
Want my re-auth deadline spreadsheet? Book a free 30-minute call and I'll send it to you afterward. You enter each learner's authorization expiration date (use initials or a client code, not names), and it fills in your check-in dates at 2 months, 45 days, 30 days, 3 weeks and 1 week before each expiration.
Please share only a brief, non-identifying description of what you're dealing with. Don't send client names, records or other protected health information through the booking form or email.
Prefer email or phone? [email protected] · 855-507-8741
— Cheryl Martin, BCBA, Behavior4Hope ABA
