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Follow a sample practice's Aetna application week by week: the public records before it goes out, a check every week, the call that finds what the committee needs, the decision, and the dates…

First seen 2026-11-05 · Last seen 2026-11-05 · Source: webmcp.com

Answer 1 · Act 6 · Transact 0 · Score: Not yet scored

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fill_prior_authorization_form

act imperative

Fill the authorization follow-up form for one outpatient behavioral health authorization, counseling or ABA ($39): the practice's email and name, the rendering clinician's NPI, the payer, the patient's name, date of birth and member ID, the service type, the CPT or HCPCS codes, the units or sessions requested (and for ABA the hours per week) and the start date, the ICD-10 diagnosis codes, and whether it is new or a renewal (a renewal adds the current authorization number and the date it expires). A clinical document (for ABA, the treatment plan) is attached on the page by a person. Nothing is sent until a person clicks the form's button, and nothing goes to the payer until payment.

Page: /prior-authorizations

Input schema

Property	Type	Required	Description
`practice_email`	string	yes	Where status emails go.
`practice_name`	string	yes	—
`clinician_npi`	string	yes	The rendering clinician's 10-digit NPI.
`payer`	string	yes	The payer or health plan, as on the insurance card.
`member_id`	string	yes	As on the insurance card.
`patient_name`	string	yes	First and last name as on the insurance card.
`patient_dob`	string	yes	Date of birth, such as 1990-04-15 or 4/15/1990.
`service_type`	string	yes	—
`cpt_codes`	string	yes	CPT or HCPCS codes, comma separated, such as 90837, 90834, or for ABA 97153, 97155. Up to 8.
`units_requested`	integer	yes	—
`unit_kind`	string	yes	—
`hours_per_week`	number	no	ABA only: hours per week requested.
`start_date`	string	yes	The first day of service, such as 2026-11-03.
`diagnosis_codes`	string	yes	ICD-10 codes, comma separated, such as F33.1, F41.1. Up to 12.
`request_type`	string	yes	—
`existing_authorization_number`	string	no	Renewal only: the current authorization number.
`existing_authorization_expires_on`	string	no	Renewal only: the day the current authorization expires.
`partner_code`	string	no	Optional. A partner code Licium gave you: your agreed price is charged instead of the list price. A code that is not active is refused and nothing is saved.

Raw JSON schema

{
  "type": "object",
  "additionalProperties": false,
  "properties": {
    "practice_email": {
      "type": "string",
      "format": "email",
      "maxLength": 254,
      "description": "Where status emails go."
    },
    "practice_name": {
      "type": "string",
      "maxLength": 200
    },
    "clinician_npi": {
      "type": "string",
      "maxLength": 40,
      "description": "The rendering clinician's 10-digit NPI."
    },
    "payer": {
      "type": "string",
      "maxLength": 200,
      "description": "The payer or health plan, as on the insurance card."
    },
    "member_id": {
      "type": "string",
      "maxLength": 60,
      "description": "As on the insurance card."
    },
    "patient_name": {
      "type": "string",
      "maxLength": 200,
      "description": "First and last name as on the insurance card."
    },
    "patient_dob": {
      "type": "string",
      "maxLength": 40,
      "description": "Date of birth, such as 1990-04-15 or 4/15/1990."
    },
    "service_type": {
      "type": "string",
      "enum": [
        "outpatient_counseling",
        "aba"
      ]
    },
    "cpt_codes": {
      "type": "string",
      "maxLength": 400,
      "description": "CPT or HCPCS codes, comma separated, such as 90837, 90834, or for ABA 97153, 97155. Up to 8."
    },
    "units_requested": {
      "type": "integer",
      "minimum": 1,
      "maximum": 5000
    },
    "unit_kind": {
      "type": "string",
      "enum": [
        "sessions",
        "units"
      ]
    },
    "hours_per_week": {
      "type": "number",
      "minimum": 0.5,
      "maximum": 60,
      "description": "ABA only: hours per week requested."
    },
    "start_date": {
      "type": "string",
      "maxLength": 40,
      "description": "The first day of service, such as 2026-11-03."
    },
    "diagnosis_codes": {
      "type": "string",
      "maxLength": 400,
      "description": "ICD-10 codes, comma separated, such as F33.1, F41.1. Up to 12."
    },
    "request_type": {
      "type": "string",
      "enum": [
        "new",
        "renewal"
      ]
    },
    "existing_authorization_number": {
      "type": "string",
      "maxLength": 80,
      "description": "Renewal only: the current authorization number."
    },
    "existing_authorization_expires_on": {
      "type": "string",
      "maxLength": 40,
      "description": "Renewal only: the day the current authorization expires."
    },
    "partner_code": {
      "type": "string",
      "maxLength": 100,
      "description": "Optional. A partner code Licium gave you: your agreed price is charged instead of the list price. A code that is not active is refused and nothing is saved."
    }
  },
  "required": [
    "practice_email",
    "practice_name",
    "clinician_npi",
    "payer",
    "member_id",
    "patient_name",
    "patient_dob",
    "service_type",
    "cpt_codes",
    "units_requested",
    "unit_kind",
    "start_date",
    "diagnosis_codes",
    "request_type"
  ]
}

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