Authorizations (Auths) & Utilization Review
What Is an Authorization?
An authorization is a prior approval from your payer agreeing to cover a specified number of units of service over a specified period. In most cases, authorizations must be obtained before services are provided. Not all payers require authorizations for all services. Authorizations are entered manually in Ritten based on information obtained directly from your payer.
Where to Find Authorizations
Client Chart → Funding tab → Authorizations section.
What Ritten Tracks Per Authorization
Authorization number, payer, type (facility vs. patient level)
Services covered (CPT codes) and procedure code modifiers
Admitting diagnosis
Authorization status (active, replaced, etc.) — set manually
Unit limits (e.g., 10 units total, no more than 3 per week) and date range
Notes
Authorization Matching Logic
When a service is generated, Ritten matches authorizations by CPT code, date range, and CPT code modifiers. When matched, Ritten automatically subtracts the units used from the authorization's remaining balance. The authorization number auto-populates into Box 23 on CMS-1500 claims and Box 63 on UB-04 claims when a claim is created.
Authorization Changes and Propagation
Changes to an authorization propagate automatically to services until the moment a claim is created. Once a claim exists, authorization changes will not carry forward to that claim.
Preventing Claim Creation Without Prior Authorization
A setting in Billing Configuration (not inside individual service rules) can prevent claim creation for specific CPT codes when no active authorization exists. Contact support to enable this for your organization.
Different Authorizations Force Separate Claims
There is only one authorization slot on a claim form. If two services have different authorization numbers — or one has an authorization and one doesn't — Ritten places them on separate claims. To combine service lines on one claim, ensure all of them reference the same authorization.
Two Authorization Entries for the Same Authorization Number
Adding two separate entries for the same authorization number is not supported and will create duplicate services. Use a single authorization entry. If different modifiers are needed, handle them through service rule overrides.
No-Show / Absent Encounters and Authorization Units
If a client no-shows or is absent:
Mark the encounter absent before a service is created — cleanest option. No service is generated and no authorization units are deducted.
If a service was created but no claim sent — archive the service to remove the authorization unit deduction.
If a claim was already submitted — the authorization cannot be removed from that claim. Contact your payer directly if you need to address the billing.
Setting an encounter type to non-billable prevents both service creation and authorization unit deduction.
Authorization Templates
Authorization templates can be configured in Billing Configuration to pre-populate standard fields for a given facility contract, saving time when entering new authorizations.
Utilization Review
Navigate to Billing → Utilization Review to track all active authorizations and identify which are approaching expiration by date or unit depletion.
Key filters: Auth Expiration Date, Min/Max Remaining Units.
Negative remaining balance: A negative number means more units have been billed than were authorized. This will likely cause claim rejections. Review the affected claims to determine which services exceeded the authorized amount.
Authorization status is set manually — Ritten does not automatically change authorization status based on dates or unit usage.
H2036 with MN Government Payers
For H2036 codes billed to MN government payers, enable both bundling and consolidation on the service rule. All relevant encounters for a single date of service will be consolidated into one claim row.