AI for ABA therapy billing, built around the work.
Generic RCM treats ABA as one more specialty. We do not. ABA is a CPT family with payer-specific authorization caps, supervision ratio rules, RBT certification compliance, and a parent-A/R problem that flatten generic billing tools. We built our AI around the three-way match across authorization, supervision, and notes, then connected the credentialing, denial prevention, and parent-billing AI alongside it.
Eight ABA codes. Each with its own rule set.
ABA billing operates on a tight family of CPT codes, each with payer-specific rules about authorization, supervision ratios, unit caps, and modifier requirements. Generic billing tools treat them as fungible. Our AI carries the rule book per CPT per payer per state, refreshed quarterly when payer policies change, and applied to every claim before it leaves.
The table to the right is the working snapshot. Authorization required, typical supervision ratio policy, and primary use case per code. Hover any row, the AI surfaces the payer-by-payer variance for your contracted payer mix.
Six ABA capabilities. Each one moves the same dollar.
The six capabilities below are how we cover the ABA revenue cycle end to end. Every one is real production code, validated by certified ABA-specialist coordinators on every claim, and accountable to a written SLA on the metric it is supposed to move.
Auth tracking, per beneficiary, per CPT.
Every active authorization tracked by payer, beneficiary, CPT, period, and unit cap. Units consumed vs units authorized in real time. Auto-reauthorization alerts at 30, 14, and 7 days. Auth-expired session billing has been zero on our active book for 12+ months.
Supervision ratio enforcement.
For 97153 and 97154, we track supervised vs direct ratio per RBT per week against the payer rule. Under-supervision alerts before claims submit. Over-claiming 97153 against supervision capacity is blocked. The Compass benchmark we publish is 20.8 percent across roster.
Auth · supervision · notes, every claim.
Every session validated against the active authorization, the supervision ratio policy, and the EHR session note for that date, time, location, and rendering provider. Match means ship. Mismatch means hold for resolution. This single control eliminates the most common post-pay takeback in ABA.
22-day BCBA enrollment average.
CredPro runs commercial and Medicaid in parallel, NPPES auto-enriches, Pre-Flight catches BACB-lookup blockers before submission, and Revenue-at-Risk surfaces the dollar cost of every day in limbo. Industry baseline is 90 to 120 days. Every day saved is roughly $533.
Clearer statements, lower DSO.
Pre-treatment VOB captures deductible, copay, coinsurance, and OOP max so parents see their responsibility before the first session. Active-book parent DSO sits in the high 30s vs the CASP-reported industry average of 58 days. The fix is not aggressive collections; it is correct intake VOB.
State-by-state rate tracker.
Six states reduced ABA Medicaid rates in FY2026; three by over 8 percent. We refresh fee schedules and expected reimbursement on every claim automatically as rate updates publish. Practices skipping this tracking typically leak 4 to 8 percent of Medicaid revenue silently per year.
Units consumed vs units authorized, live.
Authorization gap is the single largest source of preventable ABA denial. The fix is not a quarterly audit; it is the dashboard view to the right, updated every time a session note closes. Each row is one active authorization. The meter shows units consumed against units authorized. Green is healthy. Amber means the auto-reauthorization process is engaged. Red means the renewal window is closing fast.
Every authorization gets WhatsApp and SMS nudges to the family for needed reassessment, to the BCBA for the renewal packet, and to our coordinators for payer-side follow-through. The clinic does not have to chase any of it.
| Denial root cause | Comm | Medicaid | TRICARE | Self |
|---|---|---|---|---|
| Authorization expired | 9.2 | 11.4 | 4.1 | N/A |
| Units over auth | 3.8 | 7.2 | 2.6 | N/A |
| Supervision ratio missed | 4.5 | 5.8 | 1.2 | N/A |
| RBT cert expired | 2.4 | 3.7 | 0.8 | N/A |
| BCBA cred lapsed | 6.1 | 8.3 | 2.9 | N/A |
| Modifier missing | 3.2 | 4.6 | 2.1 | N/A |
| DX-CPT mismatch | 2.8 | 3.4 | 1.5 | N/A |
| Session note missing | 1.4 | 2.2 | 0.9 | N/A |
The ABA denial map. Authorization wins.
Across our anonymized ABA book, eight root causes account for over 90 percent of preventable denials. The heatmap shows the distribution by payer class. Authorization-expired and BCBA-credential-lapsed dominate on both commercial and Medicaid. Supervision ratio and RBT certification are mid-tier but consistently preventable. Session-note-missing is the smallest category and the one generic billing tools spend the most marketing dollars on, which tells you something.
Our AI is allocated proportional to where the dollars actually leak: authorization tracking and credentialing speed first, supervision and RBT compliance second, modifier and DX coding third. Most generic tools invert this ordering. Tracking matches dollars; intuition does not.
ABA outcomes from AI-tuned billing.
Measured across our ABA book. Anonymized; individual results depend on payer mix, supervision discipline, and how clean the EHR documentation is at engagement start.
Frequently asked questions: AI for ABA billing.
What ABA CPT codes does the AI cover?
How does the three-way match work?
What is BHCOE and what does the partnership do for us?
How is supervision ratio enforced?
What about authorization tracking?
How do you handle parent A/R, deductibles, and copays?
What is the credentialing speed for new BCBAs?
Do you handle Medicaid ABA rate changes by state?
How is RBT credentialing handled differently than BCBA?
Bring 90 days of ABA denials. We bring the map.
A free 30-day ABA denial audit. Send a 90-day denial dataset. We return a four-page written audit covering your denial taxonomy by CPT and payer, authorization gap analysis, supervision ratio compliance, BCBA credentialing TAT against benchmark, and a 90-day fix plan. A senior partner on the call.