The Do’s & Don’ts: ABA Claim Submission

Health insurance providers used to exclude Applied Behavior Analysis (ABA) as necessary treatment, so they did not have any billing codes specific to it. Because of that, therapists used to apply different billing codes for similar claims. This resulted in inconsistencies and confusion in claims data, and there was an increased risk of claim denials. In 2012, ABAI requested the CPT Editorial Panel to change the codes to accommodate and standardize ABA billing. In 2019, new CPT I and CPT III codes have been implemented to make insurers accept ABA treatments and to streamline billing!

That said; it can still be confusing for some therapists to deal with codes and billings because of how complex these can be. Moreover, CPT codes are constantly evolving. In some cases, the process may become confusing when there are multiple therapists working together. Here are some of the things you should and should not do when it comes to ABA claims submission:

Do’s

Submit claims correctly – Prepare a well-documented claim and send it to the payer electronically or on paper. Make sure the mailing address is correct or provide a soft copy through your EHR system, insurer’s portal, or clearinghouse.

Verify the demographic information of the client – ABA billing can be troublesome when you enter the wrong or inaccurate demographic details of your patient. That includes gender and age. So, double-check the data of the patient to avoid errors, which could result in delays or a denial.

Confirm coverage eligibility – Prior to submitting claims, make sure that the insurance policy status of the patient is up-to-date to see if they can be covered.

Be mindful of deadlines – Health insurance companies typically provide a 60 to 90-day allowance for submission of claims. Be sure to confirm the deadline and avoid filing claims at the last minute.

Get help – ABA billing can be a smoother experience for your practice when you outsource the task to reputable and experienced experts who know their way around eligibility, payments, denials, and Ars.

Don’ts

Duplicate billing – This ABA billing mistake is often a result of human error where a claim is submitted more than once. Denial may occur when this happens!

Miss the deadline – Always follow the strict time frame of the insurance company and submit claims on time.

Poor documentation – Insurance companies could reject a claim for reasons like illegible handwriting and incomplete documentation.

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