Therapy Claim Denials: CARC Codes, Habilitative Exclusions, Prior Auth | MyTherapyWizard

Working Denials: CARC Codes, Habilitative Exclusions and Missing Auths

Working Denials - CARC Codes, Habilitative Exclusions and Missing Auths - MyTherapyWizard help article card

A common trap: a benefits manager says habilitative therapy isn't covered so no authorization is needed, then the claim is denied for no authorization. Check the member's plan documents for habilitative exclusions, and record the reference number of every call.

✨ Available on: Billing

👥 From the clinician community

Shared in a pediatric therapy practice owners' advocacy group. Names are blurred.

🪄 In MyTherapyWizard

  1. Turn on the Authorization stage in Flow Settings for payers that require one.
  2. Record visits and units requested, approved and used in Authorizations, and attach the approval.
  3. Review denials with their CARC codes in ERA/Payments, then appeal or resubmit.
  4. Work Needs Action: authorization needed, missing auth documents, clients seen outside of approval, and denied claims.
  5. Look for repeat denial reasons by payer in Analytics › Denials.
Authorizations with visits and units requested, approved and used
Denials analytics with CARC reasons by payer

💡 Why it matters: most authorization denials are preventable, and the lifecycle stage stops a client from being seen before approval.

📚 See other articles in Practice Owners: Revenue & Compliance here.