Your outsourced ABA billing team, built around fast corrected claims.
ABA claims break in small, specific ways: units over the authorization, the wrong rendering NPI, a missing credential modifier. Our billing staff catch them daily, send the right fix before the payer’s window closes, and trace each repeat error to its root cause so it stops coming back.
Why ABA claims break.
ABA is billed in 15-minute units against tight authorizations, with provider and modifier rules that vary by payer and state. These are the errors we correct most often.
Units over the authorization
97153 or 97155 units billed past the approved cap, or against the wrong auth when a new one started mid-month.
Dates outside the auth range
Sessions delivered after an authorization expired or before a renewal took effect.
Rendering vs. supervising provider
Some payers want the RBT as rendering provider, some the supervising BCBA, some both. Rules vary by payer and state.
Missing or wrong modifiers
Credential modifiers (HM, HN, HO, HP) required by many Medicaid programs, plus telehealth modifiers. Requirements vary by state.
Place of service
Home (12), school (03), office (11), community (99), telehealth (02 / 10). Billed to match the session and what the auth covers.
Overlapping codes
Concurrent 97153 and 97155 time, or 97156 on the same date, billed in a way the payer doesn’t allow.
Diagnosis and eligibility
A missing or mismatched diagnosis (typically F84.0), or coverage that changed mid-auth.
Underpayments
Lines paid below your contracted rate or with units cut. We catch them at posting and pursue them instead of writing them off.
Every returned claim has one right fix.
A rejection never reached adjudication. A denial was processed and refused. A corrected claim replaces or voids a processed claim, carrying the payer’s original claim number (ICN/DCN) so it isn’t denied as a duplicate. Sending the wrong one costs weeks.
| Situation | What we send |
|---|---|
| Paid or denied, but billed with the wrong units, modifier, dates, POS, provider, or diagnosis | Replacement claim: frequency code 7, original claim number referenced |
| Should never have been billed (duplicate, wrong client, session didn’t happen) | Void / cancel: frequency code 8, original claim number referenced |
| Correct claim the payer denied (auth on file, medical necessity, misapplied policy) | Appeal or reconsideration with authorization, treatment plan, and session notes |
| Rejected at the clearinghouse or payer front end, so never adjudicated | New claim: frequency code 1, after fixing the rejection reason |
Some payers require a corrected-claim form, portal submission, or reconsideration request instead of an electronic replacement. Corrected-claim filing limits vary by payer and state.
How our team works your claims.
Dedicated billing staff, working in your system, every business day.
Triage daily
Rejections, denials, and short payments are reviewed every business day by our billing staff. Nothing is saved for a month-end batch.
Pick the right route
Was the claim wrong, or did the payer process a correct claim wrong? That decides correction vs. appeal.
Correct in your system and resubmit
We fix the claim in your practice management system so your records match the payer’s, then send the replacement, void, new claim, or appeal.
Track to payment
Each claim is followed until it pays or reaches a final determination, with the filing window watched the whole time.
Find and fix the root cause
When an error repeats, we trace it to its source (intake, scheduling, auth tracking, provider setup, or a payer rule) and tell you exactly what to change so it stops showing up on new claims.
ABA CPT code reference.
All billed per 15 minutes. Coverage, rates, and who may render each code vary by payer and state.
| Code | Service | Typically rendered by |
|---|---|---|
| 97151 | Behavior identification assessment | BCBA / QHP |
| 97152 | Behavior identification supporting assessment | Technician (RBT) |
| 0362T | Supporting assessment for destructive behavior | Technicians, QHP on site |
| 97153 | Adaptive behavior treatment by protocol | Technician (RBT) |
| 97154 | Group adaptive behavior treatment by protocol | Technician (RBT) |
| 97155 | Adaptive behavior treatment with protocol modification | BCBA / QHP |
| 97156 | Family adaptive behavior treatment guidance | BCBA / QHP |
| 97157 | Multiple-family group treatment guidance | BCBA / QHP |
| 97158 | Group treatment with protocol modification | BCBA / QHP |
| 0373T | Treatment with protocol modification for destructive behavior | Technicians, QHP on site |
What you’ll need to do →
The access and context we ask for at onboarding: where your PM system, clearinghouse, payer portals, and auth records live, and who approves what.
How we handle your data →
BAA with every client, minimum-necessary access, and the list of SOC 2-audited vendors we use, shared once an agreement is in place.
ABA billing FAQ
When is an ABA claim corrected instead of appealed?
If the claim was wrong (units, modifier, rendering provider, place of service, dates, or diagnosis), we correct it and send a replacement (frequency code 7) or void (frequency code 8) referencing the payer’s original claim number. If the claim was right and the payer applied a rule incorrectly or wants clinical justification, we appeal. Sending the wrong one usually just adds weeks.
How fast do you work corrections?
Rejections, denials, and short payments are reviewed every business day rather than saved for a monthly batch, so fixes go out while the payer’s timely-filing and corrected-claim windows are still open. Those windows vary by payer and state, and we track them per payer.
Do you bill RBT sessions under the RBT or the supervising BCBA?
It depends on the payer and state. Some require the RBT as rendering provider, some the supervising BCBA, and some both. We set this up per payer during onboarding and correct claims that went out with the wrong NPI.
Can you bill 97153 and 97155 for overlapping time?
Concurrent billing rules vary by payer. Some allow 97155 to overlap 97153 when the BCBA is directing the technician; some don’t. We follow each payer’s policy and appeal overlap denials where the policy allows it.
Do you work with Medicaid ABA programs?
Yes. We bill state Medicaid and Medicaid managed care plans for ABA, applying the state’s credential modifiers (such as HM, HN, HO, HP where used) and place-of-service rules.
Can you fix claims another biller or our in-house team submitted?
Yes. We take on backlogs of rejected, denied, or underpaid ABA claims regardless of who submitted them, as long as we have access to your practice management system or clearinghouse and the original remittance information.
Get your stuck ABA claims moving again.
Book a free 30-minute review. Bring your recent denials and rejections, and we’ll show you which can still be corrected and what’s causing them.
Book a Free Consultation