Reference guide for prior authorization requirements by major insurance payers, including visit thresholds, documentation needs, and submission methods.
Each insurance payer has unique prior authorization requirements. Some require auth before the first visit, others after a set number of visits (typically 8-12). PRACTIS maintains a database of 2,000+ payer rules, updated weekly, so you never miss a requirement.
Traditional Medicare does not require prior authorization for most outpatient PT services, but does require a physician referral and plan of care. Medicare Advantage plans, however, frequently require prior auth. PRACTIS automatically detects the patient's specific Medicare plan type and applies the correct rules.
PRACTIS tracks requirements for all major commercial payers: UnitedHealthcare (auth required after 12 visits), Aetna (auth required for all visits), Blue Cross Blue Shield (varies by state plan), Cigna (auth after 8 visits), and Humana (auth after 10 visits). These thresholds are automatically applied to each patient.
Navigate to Settings > Payer Rules to view and customize authorization requirements for each payer in your practice. You can override default rules for specific payer contracts and add custom rules for regional or specialty payers.
Join 2,400+ practice owners receiving actionable tips on AI automation, billing optimization, and compliance every Thursday.
No spam, ever. Unsubscribe anytime.