info@mentalhealthbillingservice.com
Managing denials for ABA practices should not consume your clinical leadership team. Our certified behavioral health billers provide specialized ABA billing services to handle the entire ABA revenue cycle from authorization tracking to modifier-specific claim submission.
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You bill 97153 for an RBT’s direct time, but the session note indicates BCBA supervision. The payer reclassifies the claim as 97155 (protocol modification) and reduces payment by 40%, or denies it outright.
Aetna approved 40 units for 97154 (group ABA). The 41st unit is submitted, denied as “no authorization,” and written off because timely filing expires before anyone notices.
You deliver 97153 via Zoom. Your biller submits POS 02 (telehealth) but omits modifier GT or 95, or uses POS 10 (audio-only) incorrectly. The claim fails clearinghouse validation.
A patient’s primary medical card is Blue Cross, but their ABA benefits are managed by Magellan. Your claim goes to Blue Cross and is rejected as “ineligible patient.”
Our RCM process begins before the first session and continues until the final dollar is posted. Below is the end-to-end workflow we execute for every ABA provider partner.
Benefit verification with payer (deductible, copay, session limits)
Prior authorization submission with required medical necessity documentation
Unit tracking setup per patient, per CPT code, per date range
Daily or weekly import of signed session notes from your EHR
Audit for: start/stop times, total minutes, supervision documented, modifier required
Coding correction before claim build
Clearinghouse scrub for missing data, invalid POS, or mismatched NPI
Electronic claim submission within 24 business hours of completed note
Direct routing to behavioral health payer ID (not medical plan)
Automated ERA posting or manual EOB entry within 48 hours of payment receipt
Immediate identification of underpayments or unexpected patient responsibility
Adjustment tracking for contractual allowances
Denial categorized by reason: authorization, coding, modifier, medical necessity
Correction or appeal assigned to a biller with ABA expertise
24-hour turnaround for simple corrections; formal appeal within 5 business days
Weekly AR reports by aging bucket (30, 60, 90, 120+ days)
High-dollar claims prioritized for payer follow-up
Escalation to supervisor or state insurance department for persistent denials
Coding Certification
Modifier Application
Auth Tracking
Carve-Out Routing
Fee Structure
Contract
We actively track rules for:
Top 3 reasons your ABA claims are rejected.
Dollars at risk of timely filing deadline.
Where expired visits are killing revenue.
3 specific fixes to implement immediately (even if you don’t hire us).
Upload your last 60 days of remittance advice or Schedule 15-min discovery call
You do not need to become a coding expert. Our certified billers apply these rules to every claim, ensuring 97.5% first-pass acceptance.
Accurate ABA billing requires mastery of three distinct code sets: CPT® codes describe the services rendered, HCPCS Level II codes capture specific program details or supervisory structures, and ICD-10-CM codes establish medical necessity. One mismatch across any of these three categories triggers an automatic denial or audit risk.
Positioning Statement: You can’t bill what you’re not credentialed for. We manage the entire provider enrollment process.
Adding new BCBAs or RBTs to your practice should accelerate revenue, not create billing bottlenecks. Our credentialing team manages every step of payer enrollment.
| Service | What We Handle |
|---|---|
|
Initial Provider Enrollment |
CAQH application, payer portal registration, W-9 submission |
|
Group NPI Management |
Group practice enrollment with each payer |
|
Individual Provider Credentialing |
BCBA and RBT enrollment per payer requirements |
|
Re-credentialing |
Timely renewal of expiring credentials (every 2-3 years per payer) |
|
Panel Status Verification |
Confirming active participation before claim submission |
|
Taxonomy & NPI Matching |
Ensuring correct provider type for each claim |
We don’t just manage your billing—we measure it against industry benchmarks. Below are the KPIs we track and report to you monthly.
First-Pass Claim Acceptance Rate
Overall Denial Rate
Documentation-Related Denials
Days in Accounts Receivable (DAR)
90+ Day AR as % of Total AR
Net Collection Rate
Authorization Approval Turnaround
Clean Claim Rate
97153 is adaptive behavior treatment delivered by a technician (RBT) under BCBA supervision. 97155 is adaptive behavior treatment with protocol modification delivered directly by a BCBA. The key distinction is who delivers the service and whether protocol modification occurs. Billing 97153 when a BCBA was present triggers denials or downcoding .
We maintain a payer-specific modifier matrix. For live video, most payers require POS 02 + modifier GT or 95. For audio-only sessions (where permitted), we apply POS 10 + modifier FQ. We track state parity laws and update our rules whenever policies change.
We submit clean claims within 24 business hours of receiving completed, signed session notes. Rejections from clearinghouse are corrected and resubmitted within 24 hours.
We log approved units per patient, per CPT code, per date range. Our system automatically calculates remaining units based on scheduled and billed appointments. We alert your team at 80% utilization and again 5 days before expiration.
We charge a flat percentage of collected revenue. If we don't get you paid, we don't get paid. No setup fees, no hidden software fees, no long-term contracts. Month-to-month engagement only.
Yes. We integrate with CentralReach, TherapyNotes, SimplePractice, Catalyst, AlohaABA, Rethink, and most major platforms. We can also work via secure remote access to your system.
Every payment is compared against your contracted fee schedule. Variances are flagged within 48 hours and appealed with contract documentation. We recover 60-80% of underpayments on first-level appeal.
Monthly financial reports including collections summary, denial analysis by payer, A/R aging, and authorization utilization. Weekly dashboard with real-time claim status. Quarterly business review with strategic recommendations.
We’re not for everyone. We’re for ABA owners who are tired of writing off $50k+ in denials each year.We’re not for everyone. We’re for ABA owners who are tired of writing off $50k+ in denials each year.
Simplifying mental health billing with accurate claims, faster reimbursements, and seamless revenue cycle management.
info@mentalhealthbillingservice.com
(860) 500-1471
403, Port Washington Road
