Some of Rula’s payer partners have an authorization requirement, meaning patients are initially approved for a set period of time and/or number of sessions before they must be re-approved for ongoing care. These authorizations may apply for a set period of time or number of visits, which apply from the date of intake across all therapy providers seen at Rula. To support your client’s care and ensure a smooth authorization process, please keep the following best practices in mind:
- Set expectations early: During intake, discuss the authorized treatment duration with your client and align on appropriate expectations around treatment length and graduation. When clinically appropriate, aim to conclude care by the time the authorization expires or the session limit is exhausted.
- Treatment planning: Develop your treatment plan with the authorization period in mind, with the goal of discharging once the client’s treatment goals are met.
- Clinical documentation: All notes should clearly describe symptoms that support the primary diagnosis, as well as associated functional impairment, to demonstrate that therapy remains clinically necessary.
- Reauthorization reminders: Rula will notify you as the authorization period nears its end. If additional care is needed, your documentation will be used to support the reauthorization request. Strong clinical necessity documentation will be essential.
- Adjustment Disorder diagnoses: Clients with a primary diagnosis of Adjustment Disorder may not be eligible for reauthorization by the payer unless a clinical reassessment (prior to 6 months in care) results in a new primary diagnosis and a continued need for therapy.
- Ongoing client communication: Throughout treatment, discuss the expected duration of care with your client, including the possibility of graduation or, if clinically indicated, the process for requesting extended coverage.
Questions? Reach out to our Clinical Quality team at quality@rula.com or set up a 1:1 consultation with one of our Clinical Quality Specialists.
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