Authorization.
The payer’s approval of specific services, a number of units and a date range. Work outside it is work you may not be paid for — and no amount of documentation fixes that afterwards.
Codes, units, dates. All three.
Before the work, the payer authorizes it: which services, how many units, and between which dates. In Ohio the MCO authorizes against a written plan (the RH-45 is the request). In Washington the referral itself carries a cap. In Massachusetts the approved IWRP plays the same role.
Note the word: authorization, not “prior auth” and not “pre-cert.” Those are clinical terms from a different system.
The burn-down is the number nobody shows you.
An authorization for, say, forty units is spent a tenth at a time across weeks. What is left is arithmetic you are doing in your head while doing something else, and the moment you cross the line nothing happens — no warning, no rejection. You find out when the payment comes back trimmed.
That is the most preventable unpaid work in this profession, and the fix is not discipline; it is a running “authorized / used / remaining” figure per plan or referral, visible while you are logging the activity rather than reconstructed at month end.
Related pages.
Be clear about where the software stands on this: it does not hold an authorized / used / remaining figure and will not warn you when a plan is running out. What the daily activity grid does is make the addition possible — every tenth is dated, coded, priced and attached to its claim as you enter it, so the total you have used is a filter over real records rather than a reconstruction at month end. The state guides cover how each state authorizes.
See your own week run itself.
We load your state’s codes before the call, so you are looking at a caseload like yours inside the first two minutes — not a slide deck.