In the world of ABA therapy, delivering consistent and quality care is your top priority—but what happens when claims get denied and your payments are delayed?
Denials in ABA billing don’t just impact your administrative team—they directly affect your revenue stream, provider morale, and even your ability to deliver uninterrupted care.
The good news? Most denials are preventable and fixable with the right. In this post, we’ll explore how to tackle claim denials head-on, how to avoid them moving forward, and how to create a billing workflow that supports both compliance and cash flow.
Why Denials in ABA Billing Happen So Often
It’s not unusual for ABA clinics—whether large or small—to deal with claim denials on a regular basis. More often than not, they’re caused by a handful of recurring issues. Things like missing or incorrect patient details, expired authorizations, outdated CPT or diagnosis codes, and providers not being credentialed with the payer are common culprits. Claims also get denied when documentation—like session notes or treatment plans—is incomplete or missing, or when duplicate submissions are accidentally sent.
In fact, more than 70% of denials come down to front-end mistakes or documentation gaps. If these issues aren’t addressed early, they can lead to delayed payments, added administrative stress, and frustration for both your team and the families you serve.
Step-by-Step Guide to Handling Denials in ABA Billing
Step 1: Understand the Reason for Denial
Start by reviewing the Explanation of Benefits (EOB) or Remittance Advice (RA). Don’t just resubmit the claim blindly—look at the denial code, remarks from the payer, and what specific information they’re asking for.
Pro Tip: Create a standardized system within your ABA billing services to review EOBs on a weekly basis. Assign a team member to log and categorize denials so you can spot recurring trends—this kind of proactive step goes a long way in tightening up your ABA billing process and preventing future rejections.
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Step 2: Resolve the Issue and Send the Claim Back Promptly
After identifying what went wrong, don’t wait—make the correction and resubmit the claim as soon as possible. Most insurance plans give you a limited window (usually between 90 and 180 days) to make adjustments and get the claim back in. Acting quickly not only keeps your cash flow steady but also shows payers that your ABA billing services is proactive and organized.
Here’s a quick guide to common denial reasons and how to handle them:
| Denial Type | What to Do |
| Authorization issues | Re-check benefit verification and request retro authorization if allowed |
| CPT/diagnosis coding errors | Check and update codes based on 2025 CPT changes to avoid denials. |
| Credentialing errors | Update provider info and ensure payer enrollment is active |
| Eligibility problems | Verify insurance coverage with the payer or client |
| Missing documentation | Attach progress notes, treatment plans, or session logs |
| Duplicate claim flagged | Resubmit with a note and reference number from the original |
Remember to keep a copy of every correction or appeal for audit protection.
Step 3: Submit an Appeal if Needed
Even when you’ve done everything right, a clean claim can still get denied—and that’s frustrating. But instead of letting it slide, take action and file an appeal.
Most insurance payers allow about 30 to 60 days to file an appeal, so it’s important to act quickly once you receive a denial. When preparing your appeal, make sure it’s clear, professional, and organized.
Include a concise appeal letter that explains why the claim should be reconsidered, attach the corrected CMS-1500 form, and provide all relevant documentation like session notes and authorizations.
Don’t forget to show proof that the original claim was filed on time—this could be a date-stamped copy or confirmation from your clearinghouse. The goal is simple: make it easy for the reviewer to understand your case and approve it without hesitation.
Proactive Tips to Avoid Denials in ABA Billing
Avoiding denials is always better than fixing them.
Verify Everything Upfront
Before you even schedule a session:
- Confirm the client’s insurance is active
- Verify the ABA benefit details, including limits and covered codes
- Secure prior authorizations when required
- Double-check provider eligibility and credentialing status
Doing this helps catch red flags before they cost you.
Use the Correct CPT and Diagnosis Codes
ABA billing is highly specific. With the 2025 CPT updates now live, you need to stay current. The 98000–98015 code series is now active for digital-first and telehealth sessions. Outdated codes can lead to instant denials.
Keep your team updated with:
- Crosswalk charts
- Cheat sheets for ABA-specific CPT codes
- AI tools or software that validate codes before submission
- Coding webinars or lunch-and-learns
Document Thoroughly—Every Time
Clear documentation isn’t just a billing formality—it’s your proof that services were provided as billed. Always include:
- Date, time, and location of service
- Goals addressed and activities used
- Time in/time out and staff signatures
- Client participation, caregiver involvement
- Any notable behaviors or interventions used
Track and Audit Your Claims Regularly
Don’t let denials slip through the cracks. Use a simple dashboard to track:
- Date of denial
- Reason for denial
- Correction steps taken
- Resubmission and payment status
A monthly review of denials helps you identify weak spots in your workflow—and fix them before they become habits.
Work with an Expert ABA Billing Services
Managing all of this in-house can overwhelm even the most organized practice. That’s why many ABA providers outsource their ABA billing to experts who specialize in behavioral health claims.
A professional ABA billing company will:
- Monitor denials and trends
- Submit timely appeals and corrections
- Ensure coding and documentation are compliant
- Reduce administrative burden on your team
- Provide clear, monthly financial reports
Outsourcing billing lets us focus on our clients, not codes. It’s been a game changer.
Real-Life Example: Denial to Approval in 7 Days
A small ABA clinic in Arizona received repeated denials for 97153 claims marked as duplicates. After investigation, it turned out that the clearinghouse was auto-resubmitting claims too early, without necessary updates.
By switching to manual submission, adding notes about session variation, and updating session times, the clinic saw:
- A 60% drop in duplicate claim denials
- Faster reimbursements (under 15 days)
- Less staff time spent chasing payers
Sometimes, small changes bring big results.
Conclusion
Denials happen in ABA billing, but with proactive verification, accurate coding, strong documentation, regular audits, smart appeal decisions, and expert support, you can protect your cash flow and keep your team focused—even when claims don’t go as planned.
