Hidden Barriers in Mental Health

Prior Authorization is one of the largest barriers in mental health. It often delays treatment, lead to more denials and put a burden on the workflow and productivity.

Prior authorizations are not going away. A slight overhaul on the process has been made and in effect as of March 2026. Payers now are operating under stricter guidelines streamlining the decision to respond within 72 hours for expedited requests. Standard requests must be decided and communicated in 7 calendar days. Know which codes need a prior authorization. By 2027 the paperwork will go away and usher in digitalize requests and payers will be more transparent in the denials and streamlining in real-time decisions. Note few states AZ, NJ, OH, OK, TX, WA have implemented with traditional Medicare a pilot mandatory prior authorization on certain procedures.

Here a few ways to overcome the barriers with prior authorizations:

1. Have a dedicated PA/denials administrator and set up a matrix on all the plans you and your group are contracted to know ahead of time steps taken, risk factors, standard documentation needed ( GAD-7, BAM, PCL, PHQ-9) impact on function impairment to submitting a prior authorization.

2. Set expectations upfront on the treatment to minimize delays and drop offs
   May take 5-7 days, provide communication text other messaging every 48-72 hours and establish between support like using RTM digital solution so not to be routine check-ins.
   
   
3. Track timeline on authorizations and make note of the expiration both on procedures and medications. Set-up a prior authorization template knowing the history, steps taken, risk factors. Look at ways RTM and EHR have the data you need so not to be over burden on the prior authorization.

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