Prior Auth Utilization Report

Managing Revenue Cycle

Utilization Report Overview

The Utilization Report tracks the balance between authorized services and actual billing activity. This document is a vital management tool for ensuring that your agency is providing services within the limits of state-approved authorizations and capturing all expected revenue.

• Agency Provider: Analytiq Inc.

• Reporting Period: October 01, 2025, to March 31, 2026.

• Total Authorized Amount: $2,490.00.

• Total Authorized Units: 310.

Key Financial Indicators

The summary tables at the top of the report provide a snapshot of your agency's financial health regarding authorizations:

Indicator	Value	Professional Context
Pre Auth Charges	$2,490.00	The total dollar value of services currently authorized by the payer for this period
Expected Revenue	$2,490.00	The total income your agency should receive if all authorized units are utilized and billed.
Charges Matched	$0.00	The value of services already provided that have been successfully linked to a valid authorization.
Charges Unmatched	$2,490.00	The value of authorizations that have not yet been "claimed" by a service record.

Understanding the Data Fields

To manage individual patient care effectively, users should monitor these specific columns:

• DDD ID: The unique identifier assigned by the Division of Developmental Disabilities.

• Medicaid ID: The patient's state-issued insurance identification number.

• Proc Code: The specific HCPCS/CPT code authorized (e.g., T2019 for Habilitation or H2015 for Comprehensive Community Support).

• Auth Units: The maximum number of service units (e.g., 15-minute increments or per-diem) allowed under the current PA.

• Auth Amount: The total funding allocated for those specific units.

Professional Use Cases for FieldWorker Users

1. Preventing "Unmatched" Revenue Gaps

The most critical finding in this report is that $2,490.00 remains Unmatched.

• Use Case: Billing specialists should investigate if services were provided but not correctly tagged with the Prior Auth numbers listed (e.g., 1552058649 or 4552058649). If services aren't "matched" to these numbers, the claim will likely be denied.

2. Monitoring Service Utilization

The report breaks down authorizations by patient and code, such as Andre Fuego Mandana Maya.

• Use Case: If a patient has 10 Auth Units for code T2019 but the agency has only used 2, the administrator can alert the care team to ensure the patient is receiving their full authorized level of support.

3. Expiring Authorization Management

Because this report spans through March 31, 2026, it serves as a deadline tracker.

• Use Case: Users should check the total authorized units (310) against their current schedules to ensure all units are utilized before the date range expires, preventing "lost" funding that cannot be recovered later.

4. Audit Readiness

This report acts as a "Source of Truth" for state audits.

• Use Case: During an audit, you can use the DDD ID and Prior Auth columns to prove that every dollar billed was backed by a legitimate state authorization.