Effective Date: May 7, 2025


Purpose

To avoid delays or denials by correctly submitting behavioral health services that require prior authorization separately from those that do not, when rendered on the same date of service.


Policy

If a patient receives multiple behavioral health services on the same date, and some of the codes require prior authorization while others do not, create and submit two separate encounters in Tebra.


Procedure

  1. Verify Prior Authorization Requirements
  2. Check the patient’s insurance plan or payer rules to determine which CPT codes require prior authorization.
  3. Create Two Encounters in Tebra
    • Encounter 1: 
      • Include only the services that require prior authorization.
      • Enter the valid authorization number in the "Authorization Number" field.
    • Encounter 2:
      •  Include only the services that do not require prior authorization.
      • Leave the "Authorization Number" field blank unless required by payer.
  4. Submit Each Encounter as a Separate Claim


Add Tebra Notes

In the encounter note or billing note section, indicate: “Claims split due to PA requirements.”


Notes

Submitting all codes on one claim can result in a full denial if any line item is missing required PA. This policy ensures faster and cleaner claim processing.