For Applied Behavior Analysis providers serving autistic children and their families, from a single clinic to a small multi-site group
See ABA claim denial patterns by payor and reason as they start
Denials come back one at a time, so they get worked one at a time. Nobody steps back to see that one payor started denying the same service code for the same reason a few weeks ago, often because a rule changed or a modifier is missing. By the time it shows in the monthly numbers, a month of claims carries the same problem.
What it can cost you
Example: 40 claims denied for the same missing modifier x $180 average claim = $7,200 tied up in rework, growing each week until the cause is fixed.An illustration, not a promise. Your Opportunity Scan puts a real number on it.
What the system checks overnight
- Groups new denials by payor, service code, and reason code each night.
- Flags a reason that is new for a payor, or one climbing against its own recent baseline.
- Checks whether a payor rule change in the ABA Insight database lines up with the new denials.
- Separates one-off errors from repeat causes like rendering provider, auth number, or place of service.
- Lists denials still unworked as their appeal deadline gets close.
Where it reads from
- CentralReach
- Rethink Behavioral Health
- AlohaABA
- Availity
- ABA Insight payor rules database (outside data)
Recent payor rule changes, such as modifier, telehealth, or documentation requirements, matched against the denials you are seeing.
What happens when it fires
Your billing lead gets the root cause, the claims affected, and a drafted fix summary for the team. A person corrects and resubmits.
Autonomy level: Draft for approval. The system prepares the message or task, and you approve it before anything goes out.
What we guarantee
Every denial reason that repeats within a payor is flagged the morning after the remittance posts. We agree on the metric before the Sprint starts and measure it over the first 20 business days after go-live. If we miss it, you get half your Sprint fee back. Dollar savings are tracked in your monthly saves log, reported rather than promised.
Questions
We use an outside billing company. Is this still useful?
Yes. It gives you an independent view of what is denying and why, so your calls with the billing company are about specific causes instead of a monthly total.
Does it appeal claims for us?
No. It finds the pattern and drafts the summary. Appeals and resubmissions stay with your billing team or billing company.
Do I need new software for this?
No. The system reads from the tools you already use, with read-only access by default. A guardrail layer controls exactly which data the AI can see.
What does it cost?
A 3-week Sprint is $6,000 fixed and includes the morning brief plus one automation tied to an agreed metric. Ongoing support is $1,500 a month, or $500 a month to keep it running without new automations. If the agreed metric is missed over the first 20 business days after go-live, half the Sprint fee is refunded.
How is this different from a dashboard app or a free AI kit?
A dashboard app shows numbers when you go look. A free AI kit gives you the parts, and you do the setup, the upkeep, and the checking. Here the alarms are built for your kind of business, they watch outside data like market rates and rule changes alongside yours, and on Run or Keep-Running, the person who built them keeps them working and logs what they caught.
More alarms for ABA therapy clinics
Seven more things worth watching.
- Authorizations expiring without a reauthFlag ABA authorizations nearing their end date with no reauth submitted inside that payor's lead time, so a client's care does not pause.
- Sessions scheduled past the authorizationFind ABA sessions booked after an auth end date or past the units approved for a service code, before care is disrupted or claims deny.
- Unsigned notes and sessions not billedCount ABA sessions with unsigned notes or no claim, by staff member and payor deadline, before timely filing limits close. Note content is never read.
- BCBA supervision below payor requirementsTrack BCBA case supervision against each payor's rule and RBT supervision against the BACB monthly minimum, while there is still time to catch up.
- Cancellation spikes by client or staffSpot ABA cancellation spikes by client, staff member, or clinic against their own history, so care slipping or a staff problem gets noticed early.
- RBT and BCBA credential expirationsTrack RBT and BCBA certifications, licenses, and payor enrollment so no one is scheduled on a client after a credential lapses or before it clears.
- Intake-to-start delaysSee which ABA intake step is holding up new families, from benefits check to assessment, treatment auth, and staffing, before they go elsewhere.