Use this workflow to organize evaluation requests, treatment approvals, and continuing care. Requirements vary by plan. Eligibility verification and authorizations should be checked separately; an approval does not guarantee payment.
Check whether the evaluation and treatment need approval
Confirm requirements for the patient’s current plan and the planned services. Ask whether authorization is needed for the evaluation, before treatment, or after a specified threshold. Identify whether the health plan or another organization handles the request, and obtain its current submission instructions.
Record the answer for the service and date involved. A prior patient’s approval or a different plan offered by the same insurer may not answer the question for this case.
Use the speech therapy insurance verification checklist
Collect the information required for the request
Confirm the payer’s requirements before submitting. A request may need the evaluation or plan of care, diagnosis and service codes, recommended frequency and duration, and clinical support for the requested care. The treating clinician supplies and validates the clinical information.
Give the request an owner and a status. Separate requests waiting for clinic documentation from ones submitted to the payer. Record submission confirmation and the next follow-up date so staff can see why a case is waiting.
Record exactly what the payer approved
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Authorization number and the payer or administrator that issued it.
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Patient, provider, location, and approved services or codes as applicable.
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Effective and expiration dates.
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Approved quantity and its measure: visits, sessions, units, or another stated measure.
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Conditions, reporting requirements, and the process for requesting more care.
Store the approval itself with the summary. If the decision is unclear, resolve the question before treating an assumption as permission to provide covered care.
Get the prior authorization tracker
Track approved quantities as well as expiration dates
Illustrative example: an approval allows 24 visits within 12 weeks. At three visits each week, the clinic uses those visits in eight weeks. The approval is still within its date range, but the quantity has been exhausted. Checking only the expiration date would miss the problem.
Compare attended care and upcoming appointments with the remaining authorization. Keep a separate check on any benefit limit, including a shared PT, OT, and speech allowance.
Are authorized units the same as visits?
Not necessarily. A visit is an appointment. A unit is a quantity associated with a service under the relevant code and payer rules. An authorization for 30 units does not automatically mean 30 appointments.
Always keep the payer’s approved measure as the main point of reference. For timed services, the services provided and qualifying treatment time affect the billable units. Check current coding instructions and the payer’s policy before converting units into a schedule.
ASHA guidance on timed and untimed codes
What if the therapist has not finished the note?
Patient attendance can give staff an early warning that care has occurred even when a note is unfinished. That is useful when the EMR’s final count updates only after documentation is complete. Cancellations and no-shows should not be counted as completed treatment.
For a unit-based authorization, a projection based on expected units per visit is an estimate. Label it separately from documented use and reconcile it when the record is complete. Check-in alone does not establish the actual services or billable units.
Request additional care before the approval runs out
When the clinician recommends more treatment, check the payer’s continuation process and submission window. Confirm whether the clinic needs more visits or units, a later end date, a new authorization, or another specific action. Gather the clinical evidence required for that request.
A request in progress is not an approval. Keep its status visible when reviewing upcoming appointments. If the payer denies or partially approves it, record the reason and route it to the appropriate clinician or staff member for the next step under that payer’s process.
Review authorizations when the insurance plan changes
Verify the effective date and new plan’s requirements. Do not assume an authorization issued under the prior plan will apply. This check is especially useful in recurring care, where the patient may remain on the schedule across a coverage change.
Reduce manual authorization work in your speech clinic
Wiz identifies authorization requirements, submits requests using available clinical documentation, and returns payer decisions to the clinic workflow. Cases needing documentation or clinical input are flagged for the team. Review your clinic’s visit and unit tracking needs during setup.
See Wiz for speech therapy clinicsSee prior authorization in action