ABA Recommended, Authorized, Scheduled and Delivered Hours Comparison Worksheet for Families

Use one copy for one clearly defined comparison period. Preserve the original documents. Enter “not available,” “not applicable,” or “needs clarification” instead of estimating. If two records use different service categories, units, or date ranges, keep them separate until the responsible source explains how they can be compared.

An ABA hours comparison worksheet for families is most useful when every number remains attached to its own source and decision owner, even when the records appear to describe the same care.

Families and Caregivers / Insurance, Costs and Access.

What the comparison can and cannot establish

The worksheet can identify a numerical difference when the inputs use the same unit, service category, and period. It can route a question and preserve an attributed answer. It cannot explain a gap by itself.

Important boundary: Do not treat authorization as a clinical recommendation, benefit guarantee, payment promise, provider schedule, or proof that care occurred. This worksheet cannot decide medical necessity, adequacy, coverage, billing, payment, staffing, clinical progress, make-up care, or whether hours should increase or decrease. It cannot allocate units, convert an ambiguous code, calculate a claim, revise a plan, or infer why a difference exists.

The BACB Ethics Code for Behavior Analysts addresses service agreements, documentation, billing and reporting, stakeholder involvement, continuity, and professional responsibility within its scope. The worksheet is not an ethics audit and cannot determine compliance.

Define the five layers before entering numbers

Use the label that matches the source. Do not rename an authorized unit as a recommended hour or a scheduled appointment as a delivered service.

LayerQuestion the record answersTypical sourceDecision or record ownerCommon mistake to avoidRecommended. Start with the clinical source.What service intensity did the qualified clinician or team recommend for a stated period?Signed evaluation, treatment plan, or dated recommendationResponsible clinician or teamDo not assume it is authorized, staffable, accepted, or delivered.Requested. Copy the submitted request.What did the provider submit for payer review?Request form, portal receipt, fax confirmation, or submission copySubmitting provider and payer intake processDo not assume the request matches the recommendation or has been decided.Authorized. Keep the complete decision notice.What service, quantity, period, and conditions did the payer's notice approve or otherwise decide?Complete authorization or adverse-benefit noticePayer under the member's exact product and processDo not assume approval guarantees payment or tells the provider how to schedule care.Scheduled. Use the dated calendar.What appointments did the provider place on the calendar?Schedule or appointment recordProvider scheduling and clinical operationsDo not assume a scheduled appointment happened or was billable.Delivered. Use the designated service record.What service does the responsible service record say occurred?Signed note, attendance record, or other designated recordProvider documentation, then payer adjudication where applicableDo not assume delivery proves clinical benefit, claim acceptance, or payment.

The CMS person-centered care overview emphasizes goals, preferences, values, communication, and collaborative planning. A numerical reconciliation should support those conversations, not displace them.

Choose one period, unit, and service category

Write the comparison frame at the top of every page. A weekly recommendation cannot be directly subtracted from a six-month authorization. Fifteen-minute units cannot be treated as hours unless the applicable source confirms the conversion and service category.

Comparison-frame fieldFamily entryLearner and family record label. Copy the source identifier.Start and end date. Use one period.Time zone, if scheduling dates could cross zones. Note it when needed.Exact service category, code, or plain-language label.Unit used in every row.Source that defines the unit.Included settings or modes.Excluded services or periods.Date this worksheet was last reconciled.

If a record lists a range, maximum, average, frequency, or “up to” amount, copy that qualifier. Do not replace it with a single fixed total. If an authorization spans a longer period, compare only a smaller period when the notice or responsible payer explains how the quantity applies; otherwise leave the comparison unresolved.

Build a source register before the comparison table

The source register makes the later arithmetic traceable.

LayerComplete source titleAuthor or organizationIssued or signed dateEffective periodService category and unitSecure locationCorrected or superseded?Recommended. Copy the clinical source.Requested. Copy the submission record.Authorized. Copy the complete decision.Scheduled. Copy the dated calendar.Delivered. Copy the designated service record.

Keep the complete authorization notice, not only a portal status or screenshot of one number. Keep canceled, rescheduled, and corrected appointments with their dates rather than silently rewriting the original calendar.

Compare only compatible values

Once the frame and sources match, enter the quantities. A blank difference means the records are not yet comparable. Unresolved values stay blank. Open questions remain visible.

Service category and periodRecommendedRequestedAuthorizedScheduledDeliveredCompatible comparison?Question or attributed explanationComparison row 1. Enter one compatible category.Comparison row 2. Add a separate category if needed.Comparison row 3. Keep an unresolved comparison blank.

For compatible values, a difference is simple subtraction:

Later operational quantity − earlier comparison quantity = arithmetic difference

For example, 36 scheduled hours minus 40 authorized hours equals −4 hours for the same category and four-week period. That result does not say why four hours were not scheduled, whether they should be scheduled, or whether the authorization permitted another distribution.

Do not calculate a percentage unless the numerator and denominator represent the same service category, period, unit, and status. A delivered-to-authorized percentage is not a treatment-effectiveness score, attendance judgment, utilization determination, or payment result.

Read authorization information within its real scope

The current CMS Prior Authorization API FAQ says an impacted payer's API response under CMS-0057-F must approve and identify an end date or circumstance, deny with a specific reason, or request additional information. It also describes federal timeframes for certain impacted payers and expressly notes limits, including different treatment for specified QHP issuers.

That federal FAQ does not make every ABA payer, product, service, request channel, or state program follow one workflow. The FAQ does not turn an API response into a benefit guarantee or resolve a family's notice. Use the exact member product, governing notice, provider submission, and applicable appeal or complaint route.

Authorization questionExact notice language or gapPayer or provider contact, date, and referenceAttributed answerWritten correction or next actionWhat exact service and unit was requested? Copy the answer.What was approved, denied, reduced, deferred, or requested for more information? Preserve the wording.What are the effective and end dates or circumstances? Note the dates.Which conditions, provider, setting, code, or documentation limits are stated? List the limits.Where is the complete reason and review or appeal information? Save the route.

Record gap reasons only when a responsible source supplies them

A smaller scheduled or delivered amount may reflect a start date, staffing, family availability, learner health, holidays, school, canceled appointments, access barriers, provider changes, or a clinical decision. It may also involve a record error. The worksheet must not choose among those explanations.

Difference or eventDate and quantityReported reason, quoted or closely attributedSource and ownerVerification or correction neededNext reviewRecommended versus requested.Requested versus authorized.Authorized versus scheduled.Scheduled versus delivered.Delivered versus documented, claimed, or paid, if separately reviewed.

Keep claim and payment questions in a billing or EOB record. A signed service note, claim submission, payer acceptance, allowed amount, family responsibility, and payment are separate states. This family comparison does not validate any of them.

Route questions to the owner who can answer them

The AHRQ SHARE Approach supports structured conversation about options, evidence, benefits, harms, risks, and what matters to the person. Use that broad communication structure while keeping each formal decision with its responsible owner.

QuestionBest current ownerDate askedAnswer with attributionEvidence receivedStill open?What is the current clinical recommendation and review rule? Route this clinical question.Treating clinician or team.What exactly was submitted? Ask for the submission record.Submitting provider.What did the exact member product decide? Use the notice contact.Payer contact identified in the notice.What can be staffed and scheduled? Confirm the operational answer.Provider scheduling and clinical operations.Which appointments occurred and which service records are complete? Reconcile the records.Provider records contact.How are learner experience, family burden, access, school, health, and other care being reviewed? Preserve each perspective.Learner, family, and responsible clinical team.

A family may request a joint conversation when the records conflict. Record who attended and what each person actually owns. Do not use a meeting note to overwrite the signed plan, payer notice, schedule, or service record.

Keep cancellations and possible make-up care separate

Record the scheduled appointment, the cancellation or interruption, who reported the reason, and the provider's next response. Do not automatically label an undelivered hour “owed,” “lost,” “unused,” “available,” or “make-up.” The applicable clinical plan, payer rules, authorization dates, provider capacity, and family choice may all matter.

Scheduled eventOutcomeSource of outcomeQuantity affectedProvider or payer responseFamily questionNext actionScheduled event 1.Scheduled event 2.

Urgent health or safety concerns need the appropriate immediate route rather than waiting for a reconciliation meeting. A repeated access barrier, unexplained reduction, missing notice, or disputed record can be routed through the provider, payer, regulator, advocate, or other process that actually applies.

Fictional example: five totals for one four-week period

All people, organizations, dates, records, and quantities below are fictional.

LayerFictional source and quantityRecommended.Harbor ABA Services plan, version 4: 12 direct-treatment hours per week. For this fictional four-week comparison, the plan itself states a 48-hour total.Requested.Provider portal receipt dated August 20: 48 direct-treatment hours for September 1 through September 28.Authorized.North Shore Health notice dated August 24: 40 direct-treatment hours for the same period. The notice gives a review route; this example does not interpret its adequacy.Scheduled.Provider calendar issued August 27: 36 direct-treatment hours. Scheduling reports that four authorized hours lack confirmed staff.Delivered.Signed service records through September 28: 31.5 direct-treatment hours. Two canceled appointments total 4.5 hours.Arithmetic only.Authorized minus requested = −8 hours. Scheduled minus authorized = −4 hours. Delivered minus scheduled = −4.5 hours.Open questions.The family asks the clinician whether the authorization decision changes the recommendation, asks the payer about the notice, and asks scheduling whether more appointments are available. The worksheet does not answer those questions.

The example uses the same unit, category, and period so the subtraction is valid. The arithmetic does not prove that any quantity is appropriate, medically necessary, covered, billable, paid, feasible, beneficial, burdensome, accepted, or owed. The worksheet does not direct make-up care or a plan change.