ABA Therapy Billing Services for Agencies, From 7.5%

Which ABA agencies we bill for

This service is built for autism treatment agencies, solo BCBAs and multi-site ABA groups, from 1 clinician to 6–15 clinicians, counting BCBAs and BCaBAs but not RBTs. A multi-site group is rated on its BCBAs and BCaBAs across all sites, and each site keeps its own intake and scheduling. Reasons to hand your agency's billing to us:

• Weeks of 97153 sessions sit unbilled since your biller quit.
• Clients keep running past their authorized units, and those sessions come back unpaid.
• TRICARE or Medicaid claims return for overlapping sessions or missing credential modifiers.
• RBT hours grew faster than your billing desk.
• A new BCBA or a new site is waiting on payer enrollment.

Recognize one? Tell us what your agency needs.

What we take over and what your agency keeps

Our ABA billing service runs the claim side of your agency and keeps the authorization ledger that ties sessions to payment. At the ABA rates below we track every authorization's units and end date and warn you before either runs out; requesting and renewing authorizations is part of our Complete RCM revenue cycle plan at 9.0% of insurance payments, described on our prior authorization services page. Denials go to our denial work and appeals process.

Read the workflow as text

1. Log the authorization — Approved units, codes and dates entered from each authorization letter. Owner: Our billing team.
2. Record session times — Start and stop times, rendering provider and credential on every note. Owner: Your BCBAs and RBTs.
3. Count the units — Documented minutes per code become 15-minute units. Owner: Our billing team.
4. Check overlaps and modifiers — Concurrent sessions checked by provider; credential and group modifiers added as documented. Owner: Our billing team.
5. Draw down the ledger — Billed units subtracted; low balances and end dates flagged to you. Owner: Our billing team.
6. Post and work denials — Units paid checked against units billed; each denial worked. Owner: Our billing team.

Where ABA claims lose money, and what we do about it

ABA revenue leaks where session minutes, credentials and authorized units have to agree on every claim line. Below, each failure sits next to our fix.

Unit, overlap and credential errors we catch before a claim goes out

• Units guessed from session blocks. Adaptive behavior codes bill in 15-minute units, and 8 to 22 minutes counts as one unit, according to the ABA Coding Coalition. We count units from the minutes documented per code and return any note without start and stop times.
• Two services billed for the same minutes. The Coalition says a single QHP may not report 97153 and 97155 concurrently, and TRICARE's West Region contractor pays the higher rate on concurrent care and can deny or recoup the lower one. We check every overlap by rendering provider before a claim goes out.
• The wrong credential on the line. Utah Medicaid, for example, requires a credential modifier on supervision services and denies group claims sent without a group-size modifier. We add the modifiers each payer's manual asks for when the session note supports them.

Authorization limits and code changes we track for you

• Sessions past the authorization. Under TRICARE's Autism Care Demonstration, claims without prior authorization are denied and each line should carry start and stop times. Our ledger checks every claim against its approved units and dates; when one runs past either, we ask you how to proceed before it can deny.
• Hours approved, units billed. Aetna's ABA precertification form approves hours per week for each treatment code. We convert approved hours to units in the client's ledger, so each claim is checked against the hours the plan approved.
• A new code set in 2027. The ABA Coding Coalition lists new adaptive behavior codes taking effect January 1, 2027. We bill the new codes from their effective date and flag any authorization still written in the old ones.

What our ABA therapy billing services cost

ABA agencies pay the ABA row of our rate card, set by agency size. Our fee is a percentage of insurance payments; family copays and balances carry 0%. Clinicians are counted on the 1st of each month from the rendering NPIs we billed the month before (for ABA, BCBAs and BCaBAs, not RBTs). Your rate moves with your size band the next month, in either direction. Where a state Medicaid program does not let a billing company charge a percentage, we bill your Medicaid claims at a flat fee per claim, agreed in writing before we start.

Example: an agency whose claims last month named 3 BCBAs, 1 BCaBA and 14 RBTs as rendering providers counts 4 clinicians. That is the 2–5 clinicians band, so its rate is 8.0%.

Setup is $0. Invoices 1–3: only percentage fees on that month's insurance payments, plus any statements or add-ons you order. Percentage fees and mailed statements are capped at 9.0% of that month's insurance payments; from invoice 4, the $400 minimum applies even in a month when the cap comes to less. Compare every segment on our medical billing rate card.

How we start: taking over from your biller or billing company

Taking over ABA billing puts two kinds of dates at risk: filing limits on open claims and end dates on client authorizations. Go-live, when your first claims go out, comes within 5 business days of access; any unbilled backlog follows within 10 business days of access. Clock starts with your signed agreement, signed BAA and working system logins; it extends day for day while we wait on access. Every inherited claim within 30 days of a filing, corrected-claim or appeal deadline is worked within 5 business days of access. Starts at access; covers up to 250 claims (more gets a day-1 deadline schedule); worked means submitted, corrected, appealed or returned with the fix.

Your agency sends five things:

1. The signed agreement and BAA (business associate agreement).
2. Logins to your practice-management system, clearinghouse and the system that holds session notes.
3. Current authorization letters with approved units, codes and dates for every client.
4. A roster of BCBAs, BCaBAs and RBTs with NPIs and any payer certifications, such as TRICARE's.
5. A claim-level aging export, so we work inherited claims in deadline order.

What to ask your outgoing biller for is in our guide to switching billing companies. Not ready to move? Start with The Free A/R Deadline Map: A claim-by-claim list of every unpaid insurance claim over 90 days in the aging report you send: payer, amount, the deadline it faces, the denial reason and the next action, sorted by deadline. Clock starts with your claim-level aging export and signed BAA; above 10 requests in a week, we confirm your date within 1 business day.

New BCBAs, your systems and your data

When a BCBA or BCaBA joins your agency, we file their payer enrollment. New-Clinician Enrollment: Clinicians who join while you're a client get enrollment filed with up to 5 payers each (the payer decides), with no per-payer fee. Outside that, Credentialing & Payer Enrollment is $149 per payer. Billed only after the payer confirms your effective date; $0 if denied or panel closed; filed within 5 business days of your complete packet. Status updates come every 14 days.

Your agency keeps its data-collection and scheduling tools; we work inside your practice-management system and clearinghouse under a signed BAA, and our EHR compatibility page sets out what access we need. Every payment goes straight to your practice's own bank account. We never receive, deposit or endorse your payments; we invoice you once a month. If your group also employs counselors or psychologists, their claims run through our mental and behavioral health billing service at that segment's rate.

Monthly reporting and the guarantees on your claims

Your KPI report arrives by the 10th of each month, and every metric in it carries a written definition, so you can check each number yourself; the guarantees below cover the deadlines and clocks we control.

On-Our-Watch Guarantee. If a claim misses a filing, corrected-claim or appeal deadline while it is on our watch, we pay you what it would have paid. Claims we get complete 10+ business days before the deadline; contracted rate less any copay you collected, paid automatically within 30 days of final denial; capped $10,000/month; your holds excluded.

Clock-or-Credit Guarantee. From go-live, every new claim goes out within 1 business day of complete charge data, and every denial is worked within 2 business days of posting — or $25 comes off your invoice for each late one. Mon–Fri ET business days by your system's timestamps; worked: resubmitted, appealed or returned with the fix; auto-credited; capped at monthly fee; clearinghouse outages excluded.

We publish client results only with written permission. Until we have them, judge us by the guarantees and the free Deadline Map.

Common questions

How much do your ABA billing services cost?

8.5% for 1 clinician, 8.0% for 2–5 clinicians and 7.5% for 6–15 clinicians, of insurance payments. RBTs do not count toward your size band, and setup is $0. The minimum and fee cap are on our pricing page.

Do you bill TRICARE and Medicaid ABA claims?

Yes, along with commercial plans. For TRICARE we put session start and stop times on each line and bill under the rendering practitioner, as the Autism Care Demonstration asks. For Medicaid we follow your state's manual for credential and group-size modifiers.

Can you request and renew our clients' authorizations?

Yes, on Complete RCM at 9.0% of insurance payments: authorizations are requested, tracked and renewed from your clinical documentation. On the ABA rate we track units and end dates and warn you before either runs out; your BCBA files the request.

Which practice-management software do you work with?

We work inside your existing practice-management system and clearinghouse; tell us which ones and we confirm in writing within 1 business day. Whatever the system, your session notes need start and stop times, the rendering provider and the credential, because the unit ledger is built from them.

Do we have to sign a long-term contract?

No. Leave with 30 days' notice and no termination fee. Want a run-out? We keep working the claims we submitted for 90 days at your plan rate. Decline it and we charge nothing on payments that post after you leave. Notice by email; optional run-out covers claims we submitted before your exit date, at your plan rate; handover file within 10 business days of exit.

How long does it take to switch our ABA billing?

First claims go out within 5 business days of access, after the authorization ledger is loaded. Clock starts with your signed agreement, signed BAA and working system logins; it extends day for day while we wait on access. How we handle inherited claims near a filing deadline, and its terms, is in the start section above.

What do you need from our agency to start?

The signed agreement and BAA, system logins, current authorization letters for every client, a staff roster with NPIs and a claim-level aging export. Bring the authorization letters first: the unit ledger has to be complete before the first claim goes out.

Can you credential a new BCBA joining our agency?

Yes. New-Clinician Enrollment: Clinicians who join while you're a client get enrollment filed with up to 5 payers each (the payer decides), with no per-payer fee. That covers a BCBA or BCaBA who joins while you are a client; any other enrollment is $149 per payer. Billed only after the payer confirms your effective date; $0 if denied or panel closed; filed within 5 business days of your complete packet.