Submitting a Treatment Plan: Upload, Review, Sign & Send to Care Readiness

A step-by-step guide for BCBAs

Once a treatment plan is written, it needs to make its way through Alpaca to become the official record of care and, ultimately, an authorization request to the payer. This guide walks you through that whole journey on a single screen flow:

1. Upload the treatment plan to the Treatment Plans tab

2. Review the Treatment Plan against the feedback from Treatment Plan Checker

3. Request a parent/caregiver signature - only when the client's payer requires one

4. Submit to Care Readiness, where it becomes part of the authorization request

You'll spend almost the entire time in two tabs on the client's page — Treatment Plans and Care Readiness — so let's start there.

Step 1 — Upload the treatment plan to the Treatment Plans tab

💡 Tip: If you're using Alpaca's Treatment Plan Generation Tool, you can skip this step and go directly to step #2 Review

In Alpaca EHR open the relevant client page, then click the Treatment Plans tab. This is the home for every Treatment Plan or Plan of Care for this patient.

Each box is a report. There you can find everything at a glance: the Report Type, when it was Created or Uploaded, its Checker result, the Signatures status (clinician and parent), whether it's Finalized, and quick Actions (view, download, replace, delete, unfinalized).

To upload your own completed Treatment Plan, click Upload plan PDF in the top-right.

In the dialog:

1. Choose the Report type

   1. For Initial Authorization Requests select Initial Treatment Plan

   2. For Further Treatment Authorization Request select Further Treatment Plan

1. Click Choose File and select correct file. Note that you can only upload .pdf files or .docx files

2. Click Upload.

You'll see a confirmation that the plan was uploaded, and a new box appears at the top of the view

💡 Tip: The dialog itself reminds you of the next steps — "For payers that require a parent/caregiver signature, finalize it here and then request the signature from the Parent Signed column." That's exactly what we'll do next.

Step 2 — Review & Finalize the plan

Once a Treatment Plan is uploaded, Alpaca's Treatment Plan Reviewer AI will begin auditing the file. We have compiled real payor feedback from previous escalations to better flag which issues will likely cause a treatment plan to be pended or denied. Treatment Plan Reviewer will use the specific rules that for the patient's primary insurance plan. The audit process will create 3 separate issue types:

1. Blockers - These are issues that have a very high likelihood to cause a pend or denial based on the most recent payor feedback. We highly recommend addressing these prior to submission

2. Warnings - These are suggestions to increase the likelihood of first pass approval for your Treatment Plan. They will often require some clinical discretion from the provider to verify if they are relevant. We recommend reviewing all of these to see if they apply in your scenario.

3. Pass - These are payor rules that the Treatment Plan has passed

If you select the Audited: results in the top right corner of the Treatment Plan box you can see which specific issues need to be addressed (and where relevant, which page those issues are on).

We recommend the following workflow when using the Treatment Plan Checker Tool:

1. Have an editable version of your Treatment Plan open alongside the Treatment Plan Checker Feedback

2. Reading through the Treatment Plan Checker feedback, starting with blockers

3. Make edits to your editable Treatment Plan as needed. The Checker AI will try to highlight which pages issues need to be addressed (where relevant).

4. Once you resolve a blocker or warning, select the checkbox beside the warning to remove it from the view.

5. Once you've resolved all of the warnings and blockers that are relevant, save your editable document as a PDF file

6. Back on the Treatment Plans tab, select "replace" on the relevant Treatment Plan

7. Upload the updated Treatment Plan

8. (Optional) re-run the Treatment Plan Checker and address any remaining feedback

9. Move to step 3

Step 3 — Request a parent/caregiver signature (only if needed)

For payors that require a CMS-compliant parent/caregiver signature (Tricare, Cigna, ChampVA/Spina Bifida) on the treatment plan, Alpaca offers BCBA's the ability to send plans directly to the Parent Portal for caregiver signatures. This allows the caregiver to eSign their Treatment Plan without having to log into any third party software provider. If this is not required for your Treatment Plan, you can skip straight to Step 4.

Once your Treatment Plan is finalized and ready for signature, the Signatures selection appears a Signature needed badge and two action buttons:

• Request signature - emails the caregiver a signature request in their parent portal. (If a request was already sent, this becomes Re-send request.)

• Signature already on document - use this when the parent has already physically signed the uploaded PDF; it marks the plan parent-signed without sending anything.

Click Request signature and you'll get a confirmation prompt:

Request parent signature? Only send this if the parent hasn't already signed this document. It emails the caregiver a signature request in their portal. If the parent's signature is already on the document, choose "Signature already on document" instead.

Click Send request to send it. The caregiver receives the request in their portal, and the row updates to Awaiting parent signature. When they sign, it flips to Parent signed automatically.

⚠ Two buttons, two very different actions. Request signature sends an email to the caregiver. Signature already on document sends nothing — it just records a signature you've verified is already on the PDF.

Follow-up's and Notifications

If the parent does NOT sign the Treatment Plan within 24 hours Alpaca automatically sends the Caregiver a follow-up request. If the parent still doesn't take action within 48 hours Alpaca automatically sends a notification in to the provider via email & text message.

You can also manually re-send the request at any time by selecting the "Re-send request" button

Step 4 — Submit to Care Readiness

With the plan finalized (and signed, if required), it's ready to become part of an authorization request. You can either submit the Authorization request by:

On the Treatment Plan's Tab find the relevant plan and select the "Create request"

Or alternatively, on the Care Readiness Tab, in the Benefits and Prior Authorizations Requests section, select "Create Request"

Create the request

Follow the Authorization Request Workflow by filling in:

1. Patient Plan - Select the patient insurance plan you are submitting this Authorization Request for

2. Note: If the patient has both primary and secondary insurance coverage, you must submit separate authorization requests for each plan. Complete this entire process once for the primary insurance, then repeat it to create a second authorization request for the secondary insurance.

3. Request Type - Select Prior Authorization

4. Authorization Type - Select Initial Treatment Authorization or Further Treatment Authorization

5. Authorization Start Date - select which date you are looking to start treatment. If you have already started treatment and require an authorization to be backdated, select the first date of treatment.

Then click Create.

Attach your finalized plan and submit

On the Upload Information step, go to Required Documents → Treatment Plan/Plan of Care. Click Select treatment plan/plan of care and choose your finalized plan from the list — it appears here because you finalized it in Step 2. (You can also use Upload Document to add a new file.)

(The exact required documents depend on the client's payer. Attach any other documents the payer requires.)

Then click Submit to send the request to the payer.

💡 On a treatment authorization (First or Further Treatment), this same Upload Information step also auto-extracts the requested service codes from the plan for you to review before submitting — for any payer. HMSA (BCBS Hawaii) adds an extra Modifiers column and HMSA-specific checks on top. The whole service-codes flow is walked through end-to-end in the companion guide: "Service-Code Extraction for HMSA Authorizations."

If you have any questions please feel free to reach out to the Prior Authorizations team at Support@Alpacahealth.io