BH Revenue Cycle

ABA Session-to-Billing Orchestrator

compliance

Runs the full ABA therapy session lifecycle—scheduling, data collection during the session, note generation against ABA-specific documentation standards, supervision validation, and clean billing with telehealth and concurrent-supervision code logic.

BCBARevenue CyclePractice Administrator
82–90%
First-pass clean claim rate for ABA
45 min/day
BCBA documentation time recovered
<24 hrs
Session-to-claim-submission cycle
Use Case 1

In-Session Data Collection & Note Generation

Trigger: ABA session starts

1.Load authorization, BIP, and supervision plan
2.Provide data collection scaffolds for target programs
3.Capture frequency, duration, ABC data during session
4.Generate session note from structured data + prompts at session close
5.Route to RBT for signature
6.Lock note pending BCBA supervisory co-signature within 24 hours

RBTs leave each session with a finalized note instead of charting after the workday.

Use Case 2

ABA-Aware Billing

Trigger: Session note signed and supervisory co-signature complete

1.Apply ABA-specific CPT logic (97151, 97153, 97154, 97155, 97156, 97157, 97158)
2.Calculate units per 15-minute increments
3.Validate against concurrent-supervision rules (no double-billing direct service + supervision)
4.Apply telehealth modifiers and POS per session modality
5.Pre-validate against payer ABA edit rules
6.Submit clean claims
7.Hold any claim missing supervisory sign-off

ABA claims submitted clean, with supervision compliance enforced before billing.

Use Case 3

Authorization Burn-Down Management

Trigger: Continuous monitoring across active clients

1.Track authorized vs. delivered hours per client
2.Flag under-utilization risk (clients trending below 80% by mid-period)
3.Flag over-utilization risk (clients approaching or exceeding auth)
4.Draft PA extension requests with clinical justification when warranted
5.Route to BCBA for review before submission

Authorizations get managed proactively, not discovered at adjudication.

Integrations

ABA Practice Management (CentralReach, Rethink, Theralytics)
In-Session Data Collection Apps
Supervision Tracking Module
EDI 837 / 835 Processing
BH Carve-Out Vendor APIs (Magellan, Optum BH)
FHIR R4 PA Submission

Industries

healthcare

See It In Action

A sample conversation with this agent

Start a session for client Ethan with RBT Jordan, supervision by BCBA Patel.
Session loaded. Authorization on file: 97153 (adaptive behavior treatment by protocol), 25 hours/week through end of quarter. Supervision requirement check: Patel needs to be reachable per the supervision plan and must co-sign within 24 hours. Data collection scaffolds ready for the targets in Ethan's current BIP—mand training, transitions, and adaptive skills. Jordan can log frequency, duration, and antecedent/behavior/consequence data live. Note draft will populate from data + structured prompts at session close.
Generate the session note and bill it.
Session note generated against the ABA documentation standard: medical necessity tied to BIP goals, programs run with data, behavior incident summary, parent communication, supervision check-in. Routing to Jordan for review and signature; once signed, the note locks pending Patel's supervisory co-signature within 24 hours. On the billing side: 4 hours of 97153 at one unit per 15 minutes, no concurrent-supervision conflict (Patel was reachable but not billing concurrent direct-service time), POS 02 with modifier 95 for the telehealth portion. Claim drafted, pre-validated against the payer's ABA edit rules. Submission held until Patel co-signs—billing without supervisory sign-off is a compliance violation I won't initiate.
Show me this week's authorization burn-down.
Tracking authorized hours vs. delivered hours per client across the practice. Three clients to watch: (1) Client A is at 92% of weekly auth with 2 sessions left scheduled—on track. (2) Client B is at 67% with the week half over—under-utilization risk; flagging to scheduling. (3) Client C is at 105% with 1 session scheduled—going to exceed auth without an updated PA. Already drafted the PA extension request for Client C with the clinical justification from recent progress notes—routing to BCBA for review before submission.