Billing, claims and reimbursement for Applied Behavior Analysis (ABA)

Overview

ABA providers are considered outpatient specialty providers. Authorized ABA supervisors and Autism Care Corporate Service Providers (ACSP) are allowed to bill for ABA services. View ABA maximum allowed amounts for more information.

Claims processing

In accordance with the TRICARE Operations Manual (TOM), Chapter 18 Section 4, prior authorization is required prior to rendering ABA services. Claims for services rendered without prior authorization will be denied. All claims must be submitted by BCBA/BCBA-D for services covered under the Autism Care Demonstration (ACD). Network providers can submit new claims and check the status of claims via provider self-service.

• All claims must be submitted electronically in order to receive payment for services
• 98% of claims must be paid within 30 days and 100% within 90 days
• All claims for benefits must be filed no later than one year after the date the services were provided

Claims processing and recoupments

Providers should include the start and stop times on the individual claim lines when submitting claims, even when billing for multiple services rendered by the same rendering provider on the same day. These sessions must be separated out, even when the CPT code is the same. When the times are not submitted on the individual lines, claims processing is delayed as additional research is required to confirm the correct start and stop times and corresponding charges.

Recoupment tip sheet