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Overlapping Restrictions

Overlapping Restrictions – Definition

In this tab you can indicate contract rules that specify restrictions (e.g., max hours per day, overlapping modifiers not allowed), and enforce them at the scheduling or billing stage.

Overlapping restrictions are system-enforced safeguards that:

  • Prevent multiple sessions from being scheduled for the same client or provider at the same time

  • Ensure compliance with payer rules that prohibit overlapping billing codes or overlapping authorizations

  • Avoid provider overbooking or double-booking across clients or services

Examples 

  1. Client-Level Restrictions
    A client cannot have a 97153 (1:1 ABA) session and a 97155 (supervision or direction) session running at the same time, unless permitted by the funder.

  2. Authorization-Level Restrictions
    You may not be able to bill the same CPT code across overlapping time windows if the payer prohibits it

What Happens When Overlapping Restrictions Are Triggered?

  • A hard stop may prevent session entry or scheduling.

  • A warning may pop up notifying the user of a conflict.

  • The session may fail claims validation or show as non-billable due to contract/funder rules.