Prior Authorization Compliance Intelligence

Your PA checked against
payer rules before you submit

AuraComply runs 10 payer-specific compliance checks on every ABA prior authorization — catching documentation gaps, unit violations, and credential issues before they become denials.

Built by a registered nurse. Every rule traces back to a real payer policy — not a guess.

Check My Prior Authorization See live example

Payer-specific rules per submission

Payers covered incl. Medicaid

<60s

Intake form to compliance report

100%

BCBA review on every output

The problem

Why ABA prior authorizations get denied

📋

Wrong payer language

Aetna wants different medical necessity language than Medicaid. Medicaid requires EPSDT documentation that commercial plans do not. One wrong section means a denial.

🔢

Unit limit violations

Every payer has different CPT unit caps. CMS sets an 8-hour daily MUE limit. Exceeding these triggers automatic denial — even when the clinical need is real.

🪪

Credential gaps

BCBAs must be documented correctly. Supervision hours must meet payer thresholds. A missing certification number or insufficient supervision hours kills the PA.

📅

Expired assessments

Most payers require assessments within 12 months. An expired VB-MAPP or ABLLS score is grounds for denial regardless of current clinical need.

📡

Telehealth docs missing

Telehealth PAs require consent documentation and platform verification. Missing either results in denial even when the session was clinically appropriate.

💸

Denials after submission

By the time a denial arrives, 30–60 days have passed. Revenue is delayed. Staff must restart the process. The clinic absorbs the cost with no warning.

How it works

Four steps. Under 60 seconds.

Fill the intake form

Enter patient, diagnosis, assessment, CPT codes, and provider information — the same data you already collect for every PA.

10 compliance rules run

AuraComply checks your submission against the specific payer's rules — unit limits, credentials, documentation requirements, MUE caps, and more.

Risk score + exact fixes

You see a denial risk score (0–100), every rule that failed, and the exact language needed to fix each issue before you submit.

BCBA reviews and approves

A complete PA draft is generated. Your BCBA reads every word, approves, and submits. AuraComply supports — never replaces — clinical judgment.

The compliance rules

10 payer-specific checks on every submission

Data Integrity Check

Required fields present, valid CPT codes, correct diagnosis format

RULE 01

ABA Unit Limit Check

CPT 97153 units checked against payer-specific ceiling — not a generic limit

RULE 02

Modifier Threshold Check

Whether unit volume triggers HO, GT, or HQ modifier requirement for this payer

RULE 03

CMS MUE Daily Cap Check

8-hour maximum enforced — catches overbilling before submission reaches the payer

RULE 04

Clinical Necessity Check

Required narrative keywords verified, EPSDT language checked for Medicaid submissions

RULE 05

Assessment Validity Check

Accepted assessment tool confirmed, within 12-month validity window required by payer

RULE 06

Telehealth Compliance Check

Consent documentation and platform requirements verified when telehealth is selected

RULE 07

Comorbidity Check

Diagnosis pairs that require specific clinical language are identified and flagged

RULE 08

Credential Verification Check

BCBA or BCBA-D required, supervision hours verified against payer minimum threshold

RULE 09

Family Capacity Check

Household barriers affecting treatment intensity justification — documented and flagged

RULE 10

Every submission includes

What AuraComply produces on every PA

Denial Risk Score (0–100)

Know your compliance standing before you submit — not after you are denied

Rule-by-Rule Compliance Report

Every rule that passed or failed — with the specific payer policy it references

Exact Fix Instructions

Each failed rule shows the specific action and clinical language needed to resolve it

Revenue Protection Calculation

The dollar amount protected or at risk — calculated before submission, not after denial

Structured PA Draft

A complete authorization draft ready for BCBA review — built from your data, not a template

Cryptographic Audit Trail

Every compliance decision permanently recorded — tamper-evident, HIPAA-grade documentation

Why clinics trust AuraComply

Built for compliance. Not shortcuts.

🔒

Rules — not guesses

Every check traces back to a real payer policy. Aetna's 8-hour unit cap is coded as a rule — not estimated by a language model.

👩‍⚕️

BCBA review gate

Every output is marked DRAFT. Nothing goes to a payer without your BCBA reading and approving it. Clinical judgment is always final.

📊

Explainable decisions

Every passed and failed rule is shown with its reason. You always know exactly why AuraComply flagged something — no black boxes.

🔐

Audit-grade records

Every compliance check is recorded with a cryptographic hash chain. If a payer ever audits your clinic, the record is there.

Why this is different

Built by someone who has done this work

"I am a registered nurse. I watched BCBAs — clinicians with master's degrees — spend their Friday evenings writing prior authorizations that were clinically perfect and still got denied. Not because their patients didn't need care. Because the HO modifier was missing. Because EPSDT language wasn't exact.

AuraComply does not guess at payer rules. It runs the rules I learned from watching real denials. Your BCBA still owns every submission — AuraComply makes sure nothing gets missed before it leaves your clinic."

— Ananta Lal Adhikari, RN | Founder, AuraComply

Check your next PA
before it goes out

Run a free compliance check — no account, no credit card, no commitment.

Check My Prior Authorization Free

No signup required. BCBA review mandatory on every output.
AuraComply is a clinical decision support tool — not a clinical authority.

Your PA checked against payer rules before you submit