6.7 Track authorizations with Care Readiness

Last updated: August 10, 2026

Care Readiness answers one question: "Can I actually start (or continue) a session with this client right now?" It's your single source of truth for whether a client is cleared to be seen, and it's about more than authorizations. Every payer has its own bespoke requirements before care can begin (a verified referral, a diagnosis, a completed VOB, an approved assessment authorization, and more), and Care Readiness tracks all of them together so you don't have to hold each payer's rules in your head. Tracking authorization units and expiration is one part of that; clearing the payer-specific gates to start a session is the other.

Find it on the client's profile → Insurance tab, alongside Verification of Benefits and their authorizations.

Three Readiness Gates

Each must clear before the next opens:

  • Consultation ready: cleared for the free 30‑minute consultation call.

  • Assessment ready: cleared for the BCBA's initial assessment (97151). Typically needs a verified referral and diagnosis. To accept a referral, navigate to the referrals page and click the "Accept" button. TriCare and Superior also require the assessment authorization approved first; see the TriCare and Superior guides. You can schedule the assessment once the authorization request has been submitted, even before approval is received.

  • Treatment ready: cleared for ongoing therapy (97153 / 97155 / 97156). Requires assessment ready, plus an approved, active treatment authorization on file.

Scheduling enforces these gates: Alpaca won't let you book a session past a stage the client isn't ready for.

A Red X Doesn't Always Mean You're Blocked

Each gate's checklist shows red or green per requirement, but not every red item is yours to fix, and not every red item blocks care. Requirements have an owner: you, the parent, or Alpaca.

  • Parent- and Alpaca-owned items (verifying a document, running VOB, submitting to the payer) are informational, not your to-do.

  • Alpaca can override a gate. It'll show "ready" even while an individual item underneath is still open.

Note: Trust the gate's overall ready/not-ready state, not the individual X's.

"Can I Start Now?" Depends on the Payer

This is the bespoke, payer-specific part Care Readiness tracks for you:

  • Colorado Medicaid and most commercial plans: start on or after your requested date, even before approval arrives; these payers backdate the authorization.

  • TriCare and Superior: wait for approval. These payers don't backdate, so sessions delivered early generally can't be billed. For Superior specifically, schedule appointments later in the week after submitting the authorization request to avoid start date conflicts.

Note: Unsure of a payer's rule? Check that payer's guide before scheduling.

Watch Two Numbers: Units and Expiration

Each authorization (Insurance tab) shows its covered CPT codes, units authorized, and an expiration date. Billing lapses if you run out of units or the authorization expires. Treat both as ongoing signals, not paperwork you check once.

The Re-Authorization Loop

Alpaca escalates an expiring authorization in your to-dos before it lapses. Submit the next treatment plan as a Further Treatment Authorization from Care Readiness (see Submitting Treatment Plans). A reassessment may be required first; Alpaca flags it when it applies.

Note: Treat these to-dos as urgent: an expiring authorization threatens a billable session.

Who Does What

Alpaca Handles

You Handle

Verifying uploaded documents (referral, diagnosis)

Uploading the treatment plan when it's ready

Running Verification of Benefits (VOB)

Responding to questions the payer raises

Submitting and following up authorizations with the payer

Watching units and expiration so no client's care lapses

Entering approved authorizations into Alpaca

Requesting the next authorization before the current one ends

Gate stuck with no clear reason? Email support@alpacahealth.io rather than holding the client in limbo.

Quick Reference

  • What it answers: can I start/continue a session with this client, given this payer's specific requirements, not just "is there an authorization."

  • Where: client profile → Insurance tab → Care Readiness.

  • Three gates, in order: consultation ready → assessment ready → treatment ready.

  • Red X ≠ blocked. Parent/Alpaca-owned items are informational; trust the gate's overall state and any override.

  • Can I start? Colorado Medicaid / commercial = on/after your requested date (backdated). TriCare = wait for approval.

  • Watch: authorized units and expiration date; sessions beyond either usually can't be billed.

  • Renew with a Further Treatment Authorization before the current auth lapses; Alpaca escalates the reminder.