Authorization units

An authorization is a quantity, not just a yes. The approval letter or portal record states the service code, the number of units, what one unit means, the start and end dates, and sometimes a cap per day or per week. The same code can be authorized in different units by different payers, so the unit on the claim has to match the unit the payer authorized, and the payer’s billing rules say how minutes convert to a unit. A visit that runs long does not earn extra units unless the authorization allows for it.

Payers count units as claims adjudicate, not as visits happen. Once the count reaches the authorized total, every later line denies, even when the visit took place and was medically necessary. Because claims arrive in the order they were billed rather than the order the care was delivered, a late claim can be the one that gets denied while an earlier visit paid. A report of units remaining by patient and authorization period is what keeps this from happening, and it has to be read before the care is scheduled, not after it is billed.

The mistake is tracking units against the schedule instead of against the claims. The payer’s count comes from paid lines, and corrections and recoupments move it. Reconcile units remaining to the payer’s own portal, start the reauthorization well before the units run out, and never bill a visit that EVV places outside the authorization window.