You authorized the units. You delivered the sessions. Did every one turn into a paid claim?
Reeve reads ABA authorizations, sessions, claims, and remittances today.
Its claims-side detectors read remittance and claim data, so they work here now: denied balances still inside the filing window, adjusted and written-off balances, service-code mismatches, units the payer cut back, and paid lines compared against the state's published fee schedule in the 22 states where Reeve has read one. What it will not do is guess at a dollar on your delivered-versus-billed gap. It hands you the rows and the units and says so on the report, rather than returning a quiet zero. Reeve is a read-only margin engine. You give it an export from your own system. It runs in your browser, replaces every name with a coded reference before any math, and shows you where authorized, delivered, billed, and paid stop lining up. It reads. It does not write, does not file a claim, does not touch your money. You keep the finding whether or not we ever talk again.
We price the claims side. Your delivered-versus-billed gap comes back as records and units, priced against your own rate sheet.
Denied balances still inside the filing window, adjusted balances, written-off balances, service-code mismatches, units the payer cut back, and paid lines compared against the state's published fee schedule in the 22 states where Reeve has read one, with the citation on the finding. These read remittance and claim data, so they do not care how the service was delivered. On an ABA book they run on the state Medicaid and Medicaid managed care rows only. A commercial autism benefit row is classified as commercial and excluded from every check before it runs, so it carries no dollar and no finding. Many ABA books are mostly commercial, and on a book like that most of the page comes back set aside.
Reeve prices adaptive behavior services where the state prints a code, a unit and a dollar on the page: IHCP applied behavior analysis therapy services in IN, Montana Medicaid applied behavior analysis in MT, Health First Colorado Pediatric Behavioral Therapy in CO. The Georgia DCH ASD fee schedule was read and prints no effective date, so those rows are held and refuse by name. In the 18 other states Reeve prices, the adaptive behavior schedule has not been read yet. Each one is recorded by name with the document the state publishes and the day that was last checked, and none of them prices.
Outside the states named above, Reeve's unit and duration logic is calibrated for home care units, and a per-diem or tiered line does not convert cleanly into them. So the gap between what you delivered and what you billed comes back unpriced: the delivered 97153 units that never became claim lines, the session that ran long and billed short. Reeve shows you those rows and refuses to attach a number to them. The report says so on its face instead of quietly returning a zero.
Rate variance, clawback exposure, lapsed authorizations, and rows whose rate had to be imputed all carry a real dollar figure on the report, marked as not counted toward recoverable. Reeve puts a number on them. It does not tell you that number is money you can go collect.
One detector and no others: denied balances still resubmittable inside the filing window. Nothing else reaches the headline figure on this book. Everything else is reported beside that figure, never inside it.
Denied-and-resubmittable balances are dollarized only where Reeve has read the timely-filing window from a primary source, which is 45 of the fifty states and the District of Columbia. In the 6 it has not read, AK, OR, TN, WV, WI and DC, the balance still comes back with the record attached and no dollar on it. Elsewhere those rows are surfaced at their real amount and routed to indeterminate, with no dollar figure attached. Reeve's unit and duration pricing logic is calibrated against Medicaid home care, so in ABA it reports the rows and the units and defers the dollar to your own rate sheet rather than guessing at a conversion. Reeve is read-only: it does not file, does not appeal, does not write to an EMR, does not move money.
ABA runs on four numbers that are supposed to match and quietly do not. Reeve lines them up side by side, per client, per code, per authorization period.
The payer, usually a state Medicaid program or its managed care plan, sometimes a commercial autism benefit, grants a finite number of 15-minute units per code per auth period, often a six-month window, sometimes with daily or weekly caps. Codes 97151 assessment, 97153 treatment by a technician, 97154 group, 97155 protocol modification by the BCBA, 97156 to 97158 family and group guidance. Reeve reconciles the Medicaid and managed care rows. A commercial row is classified as commercial and set aside, because the rules Reeve holds today are Medicaid rules and a commercial plan does not run on them.
The sessions your technicians and BCBAs actually ran, in units. Every ABA code is a 15-minute time-based unit, and the 8-minute midpoint rule decides a partial increment. 53 to 67 minutes is 4 units. Under 8 minutes is not separately billable.
What left your system as a claim, with the rendering provider and the right modifier. Provider level rides on HN bachelor, HO master's, HP doctoral, and some payers require their own modifiers.
What the payer actually remitted, and what it clawed back, downcoded, or denied.
The money does not leak in any one column. It leaks in the gaps between them.
- 01Delivered but never billed
- 02Authorized but under-billed against the window
- 03Billed past the authorization, CARC 198
- 04Denied for a missing or wrong modifier, CARC 16
- 05Concurrent 97153 and 97155 rejected as duplicates, CARC 18
- 06Lapsed authorization, CARC 197
- 07Rendering-provider mismatch
Reeve's claims-side detectors run on an ABA book today and produce real dollars from your own export. The delivered-versus-billed examples below are leak patterns rather than output from a Reeve run: Reeve surfaces those rows and declines to price them, and defers the dollar to your own rate sheet. Any dollar figure on this page is illustrative and synthetic.
34 units of 97153 across four clients in session notes with no matching claim line, roughly $544 at an illustrative $16 per unit, delivered and never billed.
Three authorizations for 97153 closed in 60 days with 128 authorized units unbilled at the window's close.
11 dates show 97155 billed alongside 97153, denied under CARC 18, payer required a modifier that was not applied.
One client shows 97153 billed 22 units beyond the authorized total, denied under CARC 198. Reeve caps recoverable at the authorized ceiling and shows the overage separately.
7 claims carry a provider-level modifier that does not match the rendering provider on file, CARC 16 denials.
Why an annual audit or the EMR alone misses this.
The EMR shows you three columns, not four, and never side by side. It is good at telling you what it already sent. It does not ask which delivered sessions never became a claim and which authorized units expired unused.
Timely filing turns a slow leak into a permanent one. A delivered-but-unbilled session found eleven months later may already be past the deadline. An annual audit finds these after the window closed.
Denials get worked one at a time; patterns do not. The leak is not any single claim, it is the shape across all of them.
Reeve is not a substitute for your biller or your EMR. It reads the same export they already produce and lines up the one view neither shows you.
What you may have to give back, found while it is still fixable.
Money you can collect and money you may have to return are two different numbers, and Reeve never adds them together. Exposure is the second one, and Reeve surfaces it before the payer finds it.
- 01
Care delivered past what the authorization approved, with the authorization and the delivered record side by side.
- 02
Service and attendance records that failed the payer's visit verification system, flagged with the reason they failed.
- 03
Visits and days missing a signature or a required timestamp.
- 04
Conflicts inside one person's own delivery day: two visits by the same person whose recorded times overlap, and hours that cannot both be true.
Exposure never enters the recoverable total. It sits on its own line, with its own figure, attached to the record it came from. What you do about it is yours to decide.
Plain answers, on the record.
What Reeve looks at, what happens to your file, and exactly how Reeve handles an ABA book today.
Collect is money you never captured. Cover is money a payer can still take back.
Reeve reports the two separately and never adds them together, because only one of them is yours to go and get. The Margin Review reads both on your own export and costs nothing.
One pass over your own export, in your browser. The findings are yours to keep, with no obligation.
The recovery lane. Care you delivered and never billed, units short of what was authorized, lines paid under the published rate.
Everything in Collect, plus the exposure lane. Retired codes, authorizations at the end of their period, care delivered past what was approved.
Month to month, no annual contract. Read-only in every tier. Run the free review.
Run it on your book. Priced where we can defend it.
Export one file from the system you already use. Reeve reads it in your browser, replaces every name with a coded reference before any math, and hands back a ranked worklist. The claims-side findings carry dollars. The delivered-versus-billed rows are shown and left unpriced, and the report tells you which is which on its face.
- 01
Read-only, it does not write, file, or move money.
- 02
Names coded on your machine before any math.
- 03
Your file is processed in your browser, and no name is written into any output.
- 04
The finding is yours, keep it whether or not we ever talk.
Any dollar figures in examples are illustrative and synthetic, method rather than results. Reeve never invents a rate; dollars come from the rate on your own export or the rate your own remittances actually paid most often. There is no guarantee and no promised return.