Applied Behavior Analysis (ABA)
The plan, the session,and the claim,in agreement.
Authorized, scheduled, delivered, documented, and billed units can sometimes differ. Circle helps ABA teams spot these differences and check if session documentation supports the treatment plan, the service, and payer requirements before sending claims.
1,000+
Insurance plan rulebooks ingested
Each billed unit must have the right evidence to support it. Circle links the plan, the session, and the claim.
Reimbursement structure
ABA reimbursement depends on more than the number of hours delivered. Documentation needs to support the service, the treatment targets, and the billed units within the applicable authorization. Assessment, technician treatment, protocol modification, and caregiver guidance each require evidence of the work performed. Concurrent billing rules vary by payer and program.
Common criteria evaluated
- BACB
- CASP guidelines
- Payer ABA policies
- State Medicaid requirements
What payers look for by code
- 97151 assessment
- Assessment activities, measures, observations, and findings that inform treatment recommendations.
- 97153 treatment by protocol
- Targets addressed, interventions used, and the individual's response during the session.
- 97155 protocol modification
- What the clinician evaluated, the clinical rationale, and any resulting protocol changes.
- 97156 caregiver guidance
- Guidance delivered, caregiver participation, and progress toward caregiver-training goals.
Examples of code-specific clinical criteria Circle checks before submission.
How it works in your daily routine.
Protocol modification
Notes that describe the clinical work
A protocol-modification note should explain what the clinician evaluated, the clinical reasoning, and any changes made. General staff-supervision language by itself does not show the clinical work done.
Behavior analyst note
- Complete
Client present
Documented
- Complete
Protocol evaluated
Target named from current plan
- Review needed
Change and rationale
Describe the adjustment made
- Complete
Provider signature
Captured
Built into every review.
Treatment plan alignment
Session targets and interventions are checked against the current treatment plan, and any differences are flagged for review.
Service-specific evidence
Technician treatment and protocol-modification notes are reviewed to make sure each service is described, including interventions, responses, and clinical reasoning where needed.
Unit reconciliation
Authorized, scheduled, delivered, documented, and billed units are compared so any differences in time or units can be reviewed before billing.
Concurrent services, understood
Overlapping technician and behavior analyst services are reviewed based on payer policy, provider roles, and documentation. Just having overlap does not mean both services are payable.
Reassessment packets
Progress over time, barriers, updated goals, and requested hours are organized for the payer's review cycle.
Supervision in view
Missing supervision documentation is flagged for review. Staff-supervision records and documentation for protocol-modification services have different purposes.
What customers have measured.
1,000+
Insurance plan rulebooks ingested
100%
Chart review coverage
2M+
Records processed
Explore further
Solution
Documentation
Notes, plans, and assessments guided by what reviewers expect.
Solution
Pre-Bill and Record Reviews
Documentation gaps caught before billing, and records ready for payer reviews.
Who we serve
Mental Health and Psychiatry
Documentation that supports the treatment, the code, and the level of care.
Know what each payer expects. Act before revenue is at risk.
See how Circle fits alongside the systems already in place.
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