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How to get Prior Authorizations for a Patient Plan

  1. You can get all prior authorizations for a patient plan by calling the Get Prior Authorizations for a Patient Plan API.
  2. This will return a preview of each prior authorization. In order to get more detailed information, you should call the Get Prior Authorization API with one of the ids from the response above.

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Prior Authorization Statuses Explained

When a prior authorization is in the below states, Silna is currently processing the authorization:

  • AWAITING_SILNA
  • SUBMITTED_TO_PAYOR
  • PRELIMINARY_APPROVAL -> This means the payor has provided preliminary approval but we are still waiting for either a reference number or an authorization approval letter.
  • REQUESTED
  • PARTIALLY_APPROVED

When a prior authorization is in the below states, a provider will have to take action:

  • PAYOR_DENIED
  • PAYOR_DENIED_APPEALING
  • AWAITING_PROVIDER

When a prior authorization is in the below states, the prior authorization is in a terminal state:

  • PAYOR_APPROVED -> This means that the prior authorization is complete.
  • DENIED_UNAPPEALED
  • UNNECESSARY
  • WITHDRAWN

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Reading Approval Data From a Prior Authorization

When a prior authorization is in the PAYOR_APPROVED state, then you can read the approval data from the prior authorization.

  • The approval letter will be in approval_files. Please search for the file with the document_type of APPROVAL_LETTER. This object will have file id. If you want to download it, then you will have to use the Get File API.
  • The approved treatment codes will be in approved_treatment_codes. Each entry in this list will have a list of treatment codes that were approved (treatment_codes) and the units, unit_type, time_frame, reference_number, approved_start_date, and approved_end_date. These fields will apply across all treatment_codes in the treatment_codes list.

For example, if you have treatment codes 97153, 97154, and 97155 in the list, then units=20 and unit_type=VISITS, then you have 20 visits approved across treatment codes 97153, 97154, and 97155 i.e. 97153.visits + 97154.visits + 97155.visits = 20. All of these treatment codes will have the same start/end dates and reference numbers. Below is an example of this kind of response:

  ...
  "approved_treatment_codes": [
    {
      "treatment_codes": [
        {
          "code": "97153",
          "description": "DESCRIPTION",
          "standard": "CPT",
          "treatment_code_modifiers": []
        },
        {
          "code": "97154",
          "description": "DESCRIPTION",
          "standard": "CPT",
          "treatment_code_modifiers": []
        },
        {
          "code": "97155",
          "description": "DESCRIPTION",
          "standard": "CPT",
          "treatment_code_modifiers": []
        }
      ],
      "units": "20",
      "unit_type": "VISITS",
      "time_frame": "TOTAL",
      "reference_number": "123456789",
      "approved_start_date": "2025-01-01",
      "approved_end_date": "2025-06-01"
    }
  ],
  ...

If instead, you have the below response, then you have 20 units approved for each treatment code i.e. 97153.visits = 20, 97154.visits = 20, 97155.visits = 20. In this situation, it is also possible for reference numbers to be the same or different across each approved treatment code.

  ...
  "approved_treatment_codes": [
    {
      "treatment_codes": [
        {
          "code": "97153",
          "description": "DESCRIPTION",
          "standard": "CPT",
          "treatment_code_modifiers": []
        }
      ],
      "units": "20",
      "unit_type": "VISITS",
      "time_frame": "TOTAL",
      "reference_number": "123456789",
      "approved_start_date": "2025-01-01",
      "approved_end_date": "2025-06-01"
    },
    {
      "treatment_codes": [
        {
          "code": "97154",
          "description": "DESCRIPTION",
          "standard": "CPT",
          "treatment_code_modifiers": []
        }
      ],
      "units": "20",
      "unit_type": "VISITS",
      "time_frame": "TOTAL",
      "reference_number": "123456789",
      "approved_start_date": "2025-01-01",
      "approved_end_date": "2025-06-01"
    },
    {
      "treatment_codes": [
        {
          "code": "97155",
          "description": "DESCRIPTION",
          "standard": "CPT",
          "treatment_code_modifiers": []
        }
      ],
      "units": "20",
      "unit_type": "VISITS",
      "time_frame": "TOTAL",
      "reference_number": "123456789",
      "approved_start_date": "2025-01-01",
      "approved_end_date": "2025-06-01"
    }
  ],
  ...