Checking Authorization, Claim, and Payment Status

This guide shows you where to check the status of a client's authorizations and remaining units, what to do about a benefit check, and what visibility you have (and don't yet have) into claims. It's written for BCBAs and providers.

Where to see authorization status

Open the client's record and look at two tabs:

• Care Readiness — shows the Care Readiness Status table with rows for Assessment and Treatment. Each row has a status badge (Ready or Pending) and a list of the requirements that still need to be met before you can start that stage. This is the fastest way to answer "can I start yet, and what's holding it up?"

• Insurance — shows the client's authorizations grouped into Treatment Authorization and assessment authorizations, with the authorized units and dates for each CPT code.

On the Care Readiness table, a treatment or assessment row may also show a small status pill describing where an authorization request currently sits with Alpaca — for example Draft, Submitted to Alpaca, Alpaca collecting docs, Ready to submit, Submitted to insurance, or Payor responded. Use this to see whether a pending authorization is still being prepared or has already gone to the payer.

Reading remaining units

On the Insurance tab, each authorized CPT code shows how many units are authorized and how many have been used (billed plus completed), so you can see the units remaining. A utilization label tells you whether usage is pacing as expected for the authorization window:

• On Track — usage is roughly where it should be for how much of the authorization period has elapsed.

• Behind — fewer units have been used than expected at this point in the period.

• Ahead — more units have been used than expected, so the authorization may run out before it ends.

If a client is Ahead and at risk of exhausting units, plan for a re-authorization before the current one runs out.

What "failed to create authorization" means

Occasionally you may see that an authorization couldn't be created or recorded for a client. At a high level, this means Alpaca was not able to turn an approved authorization into a usable authorization record on the client — so units may not appear on the Insurance tab and Care Readiness may still show the stage as Pending even though the payer has responded.

This is a state Alpaca resolves for you. If you see it, don't re-enter units yourself for a billable client — instead reach out to support@alpacahealth.io with the client's name so the team can correct the authorization record.

Benefit checks (VOB) and next steps

A verification of benefits (VOB) confirms the client's coverage and cost-sharing before services begin. Alpaca handles the benefit check as part of getting a client care-ready, and the outcome flows into the client's insurance information and Care Readiness requirements.

If you're not sure whether a client's benefits have been verified, or you believe coverage details are wrong or out of date:

• Check the Care Readiness tab first — requirements listed there tell you what still needs to happen before assessment or treatment can start.

• If a document shows as uploaded but not verified, or a requirement seems stuck, email support@alpacahealth.io.

If the client's plan does not allow backdating, you can only start once the assessment and/or treatment authorization is returned. Alpaca will email you when that happens, and the authorization will appear on the Insurance tab.

Checking claim status

There is currently no customer-facing view of individual claim status in Alpaca. You won't find a screen that shows whether a specific claim has been submitted, is pending with the payer, or has been paid or denied — that claim lifecycle is managed by Alpaca behind the scenes.

What you can see is the downstream result of claims: your biweekly payout. Because Alpaca guarantees the insurance-reimbursable portion of your payment every two weeks regardless of when insurance actually pays, your payout is the practical signal that services are flowing through billing. To understand how that works, see Guide to Alpaca's Payout System.

If you have a specific question about whether a service was billed or paid, contact support@alpacahealth.io.