Behavioral health authorization tracker
A downloadable CSV template for tracking prior authorizations for behavioral health services across payers. Because authorization requirements, unit limits, review timelines, and covered service categories vary by payer, plan, state Medicaid program, and contract, this template records the fields a billing team needs to monitor requests, approved units, and expiration dates without asserting any universal rule. Behavioral health coverage is frequently administered through a carved-out managed behavioral health organization, so the template includes a field for identifying which entity holds the authorization. Column structure follows the concepts described by CMS, SAMHSA, and Medicaid.gov; specific thresholds and turnaround times must be confirmed with each payer's published policy. All example rows use non-identifying placeholders and contain no protected health information.
CSV · Reviewed 2026-07-18
Download and use
The download contains headings and blank rows only. The examples below use fictional operational references so you can see the intended structure without copying patient data.
Column guide
Tracking ID
Internal reference number the practice assigns to each authorization request. Use a non-identifying sequence rather than any patient identifier.
Payer / managed behavioral health org
The entity responsible for the authorization. Behavioral health benefits may be carved out to a managed behavioral health organization separate from the medical plan, so record the specific administrator that issued the authorization.
Plan type
Commercial, Medicare Advantage, Medicaid managed care, Medicaid fee-for-service, or other. Authorization rules differ by program and plan; confirm each against the payer's current policy.
Service category
General category of behavioral health service (for example, outpatient psychotherapy, group therapy, intensive outpatient, partial hospitalization, medication management). Describe the category rather than listing procedure codes.
Authorization number
The reference number issued by the payer once a request is approved. Leave blank while the request is pending.
Request status
Current stage of the request (for example, submitted, pending, approved, partially approved, denied, appeal in progress). Update as the payer responds.
Units / visits authorized
Number of sessions, visits, or service units approved. Match billed services to this figure; unit definitions and limits vary by payer and contract.
Date submitted
Date the authorization request was submitted to the payer. Use YYYY-MM-DD format for consistent sorting.
Authorization end / expiration date
Date the approved authorization period ends. Services rendered after this date may require a new authorization; confirm renewal windows with the payer.
Notes / next action
Free-text field for follow-up reminders, peer-to-peer review outcomes, or documentation still needed. Do not enter clinical detail or patient identifiers.
Fictional example
| Tracking ID | Payer / managed behavioral health org | Plan type | Service category | Authorization number | Request status | Units / visits authorized | Date submitted | Authorization end / expiration date | Notes / next action |
|---|---|---|---|---|---|---|---|---|---|
| BH-1001 | Example Behavioral Health Network | Commercial | Outpatient psychotherapy | AUTHEXAMPLE123 | Approved | Example units | 2026-01-05 | 2026-07-05 | Renewal request due before end date; verify unit count against schedule |
| BH-1002 | Example State Medicaid MCO | Medicaid managed care | Intensive outpatient | Pending | Pending | Pending payer decision | 2026-02-12 | Not yet issued | Peer-to-peer scheduled; confirm medical necessity documentation on file |
Working instructions
- 1Record one authorization per row. Assign a non-identifying internal tracking ID; do not use patient names, dates of birth, or member IDs as the row key, and store this file only in a secured, access-controlled location — never keep an unsecured copy that could expose protected health information.
- 2Because authorization requirements, unit limits, covered categories, and review timelines vary by payer, plan, state Medicaid program, and contract, confirm each value against the specific payer's current published policy rather than assuming a universal standard. Note when behavioral health benefits are carved out to a separate managed behavioral health organization.
- 3Match billed services to the units authorized before submitting claims, and monitor the expiration date so renewal or a new request is initiated before coverage lapses. Use the notes field for peer-to-peer outcomes and outstanding documentation.
- 4Update the request status field as the payer responds, and keep supporting documentation of medical necessity organized separately in the practice's secured records system.
Sources
Related Knowledge
- Behavioral health prior authorization
How prior authorization applies to behavioral health services and where requirements vary by payer and program.
- Behavioral health eligibility and carve-outs
Identifying which entity administers behavioral health benefits when coverage is carved out to a managed behavioral health organization.
- Set up an authorization tracking workflow
A step-by-step guide to building a process for tracking authorization status, units, and deadlines.