Every authorized unit billed. Every session paid. ABA therapy billing and insurance services built for Nevada BCBAs, autism centers, and growing ABA agencies.
Nevada Medical Billing provides end-to-end ABA billing services for behavior analysts, autism treatment centers, and multi-site ABA agencies across Nevada. We manage the work that decides whether ABA claims get paid: benefit checks, authorizations, unit tracking against approved hours, 97151–97158 coding, supervision rules, and denial appeals. We bill Nevada Medicaid, all five Nevada Medicaid managed care plans, TRICARE, and commercial insurers, so your clinicians can focus on clients, not claims.
Share a few details and an ABA billing specialist will review your claims, authorizations, and denials with you.
Most ABA revenue isn't lost to bad coding. It's lost in the gaps between the treatment plan, the authorization, and the session notes. These are the gaps we close.
ABA authorizations approve a set number of units for a set period. When a client uses hours faster than planned, or a re-authorization is filed late, every session after the cutoff becomes unbillable. Nevada Medicaid requires revised authorization requests to be submitted during the existing authorization period, so a late filing can't be fixed after the fact.
When a BCBA directs a session while an RBT delivers treatment, both 97155 and 97153 may be billable, but many payers apply concurrent-billing edits. Generalist billers often delete the BCBA line to make the claim pass. That silently removes the most valuable unit of the day.
A new BCBA or RBT who isn't enrolled with a payer, linked to your group, or registered with the Nevada ABA Board can't be paid for sessions they've already delivered. Agencies that hire faster than they credential lose weeks of revenue per new clinician.
ABA codes are billed in 15-minute units. When session notes, start and stop times, and billed units don't match, payers deny or recoup during audits, sometimes months after payment.
Payers require different rendering-provider setups and credential-level modifiers for BCBAs, BCaBAs, and RBTs. A claim built for one payer's rules gets denied by the next.
Nevada ABA agencies work under three rulebooks at once:
Nevada Medicaid: ABA is billed under Provider Type 85, following Medicaid Services Manual Chapter 3700. Initial assessments and re-assessments don't need prior authorization, but adaptive behavior treatment does, using Form FA-11E. Since January 2026, most Medicaid clients are enrolled in one of five managed care plans, each with its own authorization process.**
Nevada's autism insurance mandate: State-regulated health plans must cover autism screening, diagnosis, and treatment for members under 18, or until 22 if still in high school, with an ABA benefit equal to $72,000 per year. Self-funded employer plans are governed by federal law instead, so benefits must be verified plan by plan.**
State licensing: Behavior analysts and assistant behavior analysts are licensed, and RBTs registered, through the Nevada State Board of Applied Behavior Analysis. Payer enrollment depends on those credentials being current.**
Las Vegas has the largest concentration of ABA providers in the state, followed by Henderson and Reno, so payer competition for authorizations and network spots is strongest there.
Our ABA insurance billing services cover the full revenue cycle, managed by a team that bills only behavioral health and ABA. Choose complete managed billing or the services your agency needs most.
We confirm active coverage, ABA-specific benefits, age limits, annual caps, visit and unit limits, copays, deductibles, and whether the plan is state-regulated or self-funded. Families get a clear cost estimate before therapy starts. Eligibility Verification
We submit initial authorizations with the treatment plan and assessment results, track approved units by code for every client, and file re-authorizations well before expiration with the updated plan and progress data. For Nevada Medicaid, we prepare FA-11E requests so they aren't pended for missing information. Prior Authorization
We convert session notes into claims: the right CPT code, rendering provider, credential modifier, place of service, and units that match documented time. Every claim is checked against remaining authorized units before it goes out. Medical Coding
Claims are scrubbed for payer-specific edits, concurrent-billing rules, NCCI edits, and unit limits, then submitted within 48 hours of the session.
We work every denial, find the root cause, correct and resubmit, or appeal with treatment plans, session data, and medical necessity documentation. Denial Management
We post ERAs daily and compare each payment to your contracted rates and Nevada Medicaid fee schedules. Short payments and recoupments are flagged and disputed. Payment Posting
We follow up on every open claim by dollar value and timely filing deadline, including old A/R left by a previous biller. AR Follow-Up
We enroll new clinicians with Nevada Medicaid, the five MCOs, TRICARE, and commercial plans, link them to your group, keep CAQH current, and track revalidation dates. Credentialing
When a family's plan has no in-network ABA provider nearby, we build and negotiate single case agreements so you can treat the client and get paid.
Clear statements, payment plans, and respectful billing calls that protect your relationship with families. Patient Billing
Monthly reports show revenue by client, clinician, code, and payer, plus authorization utilization, denial trends, and A/R aging. Revenue Cycle Management
Authorization utilization review for every active client
Denial and concurrent-billing edit analysis
Credentialing gap check for every BCBA and RBT
Note: We respond within 1 business day. No obligation.
ABA codes are time-based, provider-specific, and capped by authorization. Our coders check all three on every claim.
BCBA assessment and treatment-plan development, billed per 15 minutes. We confirm the units match face-to-face and non-face-to-face time allowed by the payer, and that re-assessments fall within the payer's frequency limits.
Technician-administered assessment under BCBA direction (97152), and supporting assessment for severe destructive behavior with two or more technicians (0362T). We verify the setting and staffing the code requires.
The core RBT direct-therapy code. We match units to session start and stop times, check remaining authorized units, and apply the rendering-provider rules each payer uses for technicians.
BCBA-directed treatment, often delivered while an RBT runs 97153. We apply each payer's concurrent-billing policy so supervision units are kept when the payer allows them, not deleted to pass an edit.
Technician-led (97154) and BCBA-led (97158) group sessions. We confirm group size limits and that each client has group units authorized.
Family adaptive behavior treatment guidance, with or without the client present (97156), and multiple-family groups (97157). We confirm caregiver attendance is documented, since this is a common audit target.
Treatment requires two or more technicians in a specialized setting. We verify the setting, staffing, and medical necessity documentation before billing.
We apply payer-required credential modifiers (HN, HO, HP, HM, and Nevada Medicaid's provider-level modifiers), telehealth modifiers (95, GT), group modifiers, and the right place of service: office (11), home (12), school (03), telehealth (02, 10), or community (99). Diagnosis coding to F84.0 and related codes supports medical necessity.
Codes reflect current CPT; payers' concurrent-billing and modifier rules vary and are applied per plan.
ABA denials usually come from a handful of causes. We sort every denial by cause, fix the claim, and fix the process so it doesn't repeat.
| Denial cause | How we resolve it |
|---|---|
| No or expired authorization | Check auth history, request retro-authorization where the payer allows, and tighten unit tracking |
| Units over authorized limit | Reconcile units to the auth, rebill correctly, and alert you before the next overage |
| Concurrent 97155/97153 edit | Apply the payer's concurrent-billing policy and appeal with supervision documentation when both services are allowed |
| Rendering provider not enrolled | Fix enrollment or group linkage, then rebill within timely filing |
| Missing or wrong modifier | Correct credential and telehealth modifiers per payer and resubmit |
| Medical necessity | Appeal with the treatment plan, assessment scores, and progress data |
| Post-payment audit or recoupment | Prepare session notes, supervision logs, and unit reconciliation for the payer |
Every month you get a denial report by payer, code, clinician, and cause, so you can see what changed.
A clinician who isn't enrolled can't be paid. We handle enrollment for every role your agency bills:
Nevada Medicaid Provider Type 85: group enrollment and individual specialties for licensed behavior analysts, psychologists, assistant behavior analysts, and RBTs, with each individual linked to your PT 85 group**
Nevada Medicaid MCOs: Anthem, CareSource, Health Plan of Nevada, Molina, and SilverSummit**
TRICARE and commercial plans: including payer-specific rules for billing RBT services under a supervising BCBA**
Ongoing upkeep: CAQH attestations, revalidations, Nevada ABA Board license and registration dates, and new-hire onboarding**
We at Nevada Medical Billing offer top notch ABA therapy billing and full rcm services to the ABA Agencies of All sizes. Our services are ideal for:
| Agency type | What we handle for you |
|---|---|
| Solo BCBAs and small practices | Full billing without hiring staff; you stay focused on clients |
| Growing ABA agencies | Credentialing for new hires, authorization tracking across a rising caseload |
| Multi-site autism centers | Location-level reporting, standardized workflows, and centralized A/R |
| Home- and community-based ABA | Place-of-service accuracy and travel-heavy scheduling reconciled to claims |
| Clinic-based and school-partnered programs | Group codes, school POS, and payer rules for school-day services |
| Multi-service therapy groups (ABA, speech, OT) | One billing team across service lines |
| Agencies serving military families | TRICARE Autism Care Demonstration billing and authorizations |
| Payer category | Plans |
|---|---|
| Nevada Medicaid | Fee-for-service Nevada Medicaid and Nevada Check Up (Provider Type 85) |
| Nevada Medicaid managed care | Anthem Blue Cross and Blue Shield, CareSource, Health Plan of Nevada, Molina Healthcare of Nevada, SilverSummit Healthplan |
| Military | TRICARE Autism Care Demonstration (families at Nellis and Creech Air Force Bases and across Nevada) |
| Commercial | Anthem BCBS Nevada, UnitedHealthcare/Optum, Aetna, Cigna, Hometown Health, Prominence Health Plan |
| Marketplace | Nevada Health Link plans |
| Self-funded employer plans | Benefits verified plan by plan, since state mandates may not apply |
Out-of-network plan with no local ABA provider? We negotiate single case agreements.
We bill directly in the system you already use, including CentralReach, Rethink, Motivity, AlohaABA, Theralytics, Artemis ABA, TherapyNotes, and SimplePractice. No exports, no duplicate data entry, no software switch. EHR Integration
We make the transition to outsourced ABA billing simple and structured, typically completing onboarding within 2–4 weeks. From reviewing your current billing workflows and verifying payer requirements to coordinating claims, authorizations, and reporting, our team works to ensure continuity with minimal disruption to your practice.
Free ABA billing audit: We review 90 days of claims, denials, authorizations, and A/R, and show you the revenue at stake.**
Secure setup: We sign a BAA and connect to your practice management software, clearinghouse, and payer portals.**
Credentialing check: We confirm every BCBA, BCaBA, and RBT is enrolled, linked to your group, and current with the Nevada ABA Board.**
Authorization inventory: We load every active client's authorization, approved units by code, and end date into tracking before the first claim goes out.**
Go-live: Daily charge entry, scrubbing, and submission begin.**
Legacy A/R cleanup: We work old claims in parallel so nothing ages past timely filing.**
Monthly review: KPI report and a call with your dedicated ABA account manager.**
These are the performance standards we manage your revenue cycle to, based on industry best practices for ABA billing.
| KPI | What it measures | Best-practice target |
|---|---|---|
| First-pass clean claim rate | Claims paid without rework | 95% or higher |
| Denial rate | Claims denied on first submission | Under 5% |
| Days in A/R | Average time from session to payment | Under 35 days |
| Net collection rate | Collectible dollars actually collected | 96% or higher |
| Auth-related denials | Sessions denied for expired or exceeded auths | Near zero, with unit tracking |
| Claim submission | Time from session to claim sent | Within 48 hours |
Sessions delivered after an authorization ended or ran out of units
RBTs or new BCBAs billing before enrollment or group linkage was complete
Units billed that don't match session start and stop times
Caregiver training (97156) delivered but never billed
Medicaid MCO claims sent to the wrong plan after a client changed coverage
Underpayments against contracted rates
ABA billing services are usually priced as a percentage of monthly collections, commonly 4–5%. Agencies with high volume and steady authorizations sit at the lower end; agencies needing heavy authorization work, credentialing, or old A/R cleanup sit higher. There are no setup fees, the agreement is month-to-month with 30-day notice, and you get a fixed quote after your free audit.
| Factor | In-house biller | Nevada Medical Billing |
|---|---|---|
| Cost | Salary, benefits, software, training | One fee tied to collections |
| ABA coding | Learned on the job | Team that bills ABA codes daily |
| Authorization tracking | Spreadsheets and memory | Units checked on every claim |
| Concurrent-billing rules | Often deletes the BCBA line | Applied payer by payer |
| Credentialing new hires | Backlogs while hiring | Started on the hire date |
| Absences and turnover | Billing stops | Backup team keeps working |
"Our cash flow will drop during the transition." We work old A/R in parallel while new claims go out.**
"Authorizations will slip through the cracks." Every active auth is loaded before we submit a single claim.**
"We'll lose visibility." You see every claim in your own software, plus a monthly review call.**
"We'll have to change software." No. We bill inside the system you use now.**
"We'll be locked in." You won't. The agreement is month-to-month with 30-day notice.**
ABA billing follows CPT and ICD-10-CM guidelines, payer clinical policies, NCCI edits, Nevada Medicaid MSM Chapter 3700, and HIPAA. Our workflows check authorization limits, supervision documentation, credential-level billing, and unit accuracy on every claim, and we sign a Business Associate Agreement before accessing any client data.
Nevada ABA providers choose us for specialized billing support, accurate claim submission, authorization tracking, denial management, and consistent follow-up. We help applied behavior analysis practices reduce administrative burdens, improve reimbursement workflows, and maintain compliance with payer requirements. They choose us because:
ABA-only workflows: Authorization, units, and supervision rules built into every claim.**
Nevada expertise: Provider Type 85, FA-11E, the five Medicaid MCOs, the state autism mandate, and Nevada ABA Board requirements.**
Revenue protection: BCBA supervision units kept when payers allow them.**
Dedicated account manager: One person who knows your agency and your payers.**
Clear reporting: Revenue by client, clinician, code, and payer every month.**
No lock-in: Month-to-month agreement with 30-day notice.**
Las Vegas: The state's largest concentration of ABA agencies, autism centers, and in-home ABA programs. **Las Vegas page
Henderson: Growing clinic-based and in-home agencies with heavy commercial and self-funded plan volume. **Henderson page
North Las Vegas: Agencies serving many Nevada Medicaid and MCO families, plus military families near Nellis AFB. **North Las Vegas page
Reno: ABA providers serving Washoe County and families from rural northern Nevada. **Reno page
Carson City: Smaller agencies and rural programs now billing CareSource and SilverSummit. **Carson City page
We also support ABA providers in Sparks, Summerlin, Pahrump, Elko, Mesquite, and Fallon, and telehealth caregiver training statewide.
We help Nevada ABA agencies close authorization gaps, keep supervision revenue, fix denials, and clear old A/R.
Free 90-day review · No obligation · HIPAA compliant
Behavioral health billing servicesMental health billing servicesPrimary care billing servicesABA billing services cover benefits verification, authorizations and re-authorizations, coding and charge entry, claim submission, payment posting, denial management, A/R follow-up, BCBA and RBT credentialing, and family billing. End-to-end ABA billing services manage all of it, from intake to final payment.
Most ABA billing companies charge 4–9% of monthly collections. Your rate depends on claim volume, authorization workload, and services included. We give a fixed quote after a free audit.
Often yes. When a BCBA directs treatment while an RBT delivers it, many payers allow both codes, but each payer sets its own concurrent-billing rules. We apply those rules per plan instead of deleting the BCBA line.
Initial assessments and re-assessments don't need prior authorization. Adaptive behavior treatment does, using Form FA-11E, under Provider Type 85 and Medicaid Services Manual Chapter 3700.
State-regulated plans must cover autism treatment, including ABA, for members under 18, or until 22 if still in high school, with an annual ABA benefit equal to $72,000. Self-funded employer plans follow federal rules, so we verify each plan's benefits.
Yes. We bill the TRICARE Autism Care Demonstration for military families across Nevada, including families stationed at Nellis and Creech Air Force Bases.
Third-party ABA billing means an outside company handles your insurance claims, authorizations, and collections on your behalf. Your agency keeps control of clinical care and sees every claim.
Yes. Solo BCBAs and small practices get the same authorization tracking, credentialing, and denial work as large agencies, priced on collections so cost scales with your caseload.
Yes. We enroll RBTs where payers allow it, link them to your group, and track Nevada ABA Board registration and payer revalidation dates.
Yes. We bill inside CentralReach, Rethink, Motivity, AlohaABA, Theralytics, Artemis ABA, and other ABA systems.
Most agencies go live in 2–4 weeks. We load active authorizations first and work old A/R in parallel so cash flow continues.