Insurance Billing Solutions for ABA

Supergood | Insurance Billing Solutions for ABA API

Alex Klarfeld

Alex Klarfeld

— 6 min read
Supergood | Insurance Billing Solutions for ABA API

Programmatically access benefits verification, prior authorizations, ABA session charge entry, claims submission, and payment reconciliation workflows in Insurance Billing Solutions for ABA with a stable REST API. Supergood builds and operates production-grade, unofficial integrations so your team can automate critical billing pipelines without heavy custom engineering.

Insurance Billing Solutions for ABA (by ABA Building Blocks) is a specialized revenue cycle service for ABA therapy providers that handles eligibility & benefits checks, authorization management, claims submission, payment posting, and denial follow-up. With an unofficial API, you could synchronize patients and payers from your EHR, validate and track authorizations, convert session notes into clean service lines, submit 837P claims, and reconcile ERAs/EOBs—all in one automated flow.

If you’re a healthcare tech startup building practice management, EHR, or billing tools for ABA providers, integrating with Insurance Billing Solutions for ABA unlocks concrete data flows and features:

  • Pull: Patient demographics, payer profiles, authorization records with remaining units, session/charge status, claim statuses, ERA/EOB summaries
  • Push: New/updated patients from your EHR, ABA sessions mapped to CPT codes and units, compliant modifiers and POS, claim submissions referencing authorizations
  • Build: Authorization-aware scheduling, automatic charge entry from session notes, claim generation for 837P, reconciliation dashboards driven by ERAs and adjustment codes

What is Insurance Billing Solutions for ABA?

Insurance Billing Solutions for ABA is a billing and revenue cycle management service tailored to ABA therapy practices. Their teams manage front-end eligibility, prior authorizations, charge capture, claim submission to commercial and Medicaid payers, payment posting from ERAs, and denial management so providers can focus on care.

Core service areas include:

  • Eligibility and benefits verification for ABA services
  • Prior authorization initiation, tracking, and renewals
  • Charge entry from session notes aligned to ABA CPT codes (e.g., 97151, 97153, 97155, 97156, 97158)
  • Professional claims (837P) submission through payer portals or clearinghouses
  • ERA/EOB posting, adjustments, and denial/appeal handling
  • Payer policy tracking (POS, modifiers, unit limits) and documentation management

Common data entities:

  • Patients/Clients (demographics, insurance, diagnoses)
  • Providers (BCBA/BCaBA/RBT) and supervising relationships
  • Payers and plan policies
  • Authorizations (service code, allowed units, date range)
  • ABA Sessions/Encounters (date, CPT, units, modifiers, POS, notes)
  • Claims (headers, service lines, statuses)
  • Remittances/ERAs (payments, adjustments, reason codes)
  • Denials/Appeals and supporting documents

The Insurance Billing Solutions for ABA Integration Challenge

Organizations rely on Insurance Billing Solutions for ABA to run daily RCM, but turning portal-first workflows into automated pipelines is hard:

  • Payer-specific ABA rules: Unit caps, daily/weekly limits, POS requirements, and modifier rules vary by payer and plan
  • Supervision nuances: Rendering vs. supervising provider relationships must be encoded consistently
  • Documentation dependencies: Treatment plans, evaluation reports, and authorization letters must be referenced or attached per payer guidance
  • Portal and batch variability: Mix of web portals, clearinghouse EDI, SFTP drops, and timing windows
  • Compliance and audit: PHI, audit trails for charge edits, and retention policies require careful handling

How Supergood Creates Insurance Billing Solutions for ABA APIs

Supergood reverse-engineers authenticated browser flows, batch interfaces, and network interactions to deliver a resilient API endpoint layer.

  • Handles username/password, SSO/OAuth, and MFA (SMS, email, TOTP) securely
  • Maintains session continuity with automated refresh and change detection
  • Normalizes ABA authorizations, sessions, and claims so you can integrate once across payers
  • Aligns with customer entitlements and service scope to ensure compliant access
  • Bridges batch exports and clearinghouse EDI flows with signed URL retrieval and delivery

Use Cases

EHR-to-Billing Synchronization

  • Push client and provider rosters from your EHR into the billing workflow
  • Keep demographics, insurance, and diagnoses consistent across systems
  • Map sessions and notes into compliant CPT lines automatically

Authorization-Aware Scheduling and Eligibility

  • Validate authorizations before scheduling or charge creation
  • Track remaining authorized hours/units to prevent denials
  • Surface payer-specific rules, POS, and modifier requirements to schedulers

ABA Session Intake and Charge Entry

  • Convert session notes to service lines (e.g., 97153 individual treatment, 97155 protocol modification)
  • Apply modifiers (e.g., telehealth) and place-of-service codes consistently
  • Flag discrepancies (e.g., missing authorization, over-utilization) in real time

Claims Generation and Reimbursement Automation

  • Bundle validated sessions into 837P claims and route via clearinghouse or payer portal
  • Monitor claim statuses and post ERAs with line-level adjustments
  • Drive denial workflows with CARC/RARC codes and audit attachments

Audit and Compliance

  • Export charge and claim audit packets with timestamps, provider attribution, and reason codes
  • Maintain machine-readable trails from session to claim to remittance
  • Prove medical necessity and authorization linkage during reviews

Available Endpoints

Authentication

POST /sessions: Establish a session using credentials. Supergood manages MFA (SMS, email, TOTP) and SSO/OAuth when enabled. Returns a short-lived auth token maintained by the platform.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/sessions \
  --header 'Authorization: Basic <Base64 encoded token>' \
  --header 'Content-Type: application/json' \
  --data '{
    "username": "[email protected]",
    "password": "<password>",
    "mfa": {
      "type": "totp",
      "code": "123456"
    }
  }'

Example response

{
  "authToken": "eyJhbGciOi...",
  "expiresIn": 3600,
  "user": {
    "id": "u_7b28c9",
    "name": "Billing Admin",
    "entitlements": ["patients", "authorizations", "sessions", "claims"]
  }
}

Authorizations

GET /authorizations: Retrieve payer/patient authorizations with allowed units, covered codes, and date ranges. Use this to validate scheduling and charge creation.

Query parameters

  • patientId: string
  • payerId: string
  • cptCode: string (CPT/ABA)
  • activeOn: ISO 8601 date
  • authorizationNumber: string

Example response

{
  "items": [
    {
      "authorizationId": "auth_5a12f8",
      "authorizationNumber": "AUTH-TX-2026-00421",
      "patientId": "pat_91c0ef",
      "patientName": "Avery Johnson",
      "payerId": "payer_bcbs_tx",
      "serviceCode": "97153",
      "modifiersAllowed": ["95"],
      "unitsAuthorized": 320,
      "unitsUsed": 96,
      "unitsRemaining": 224,
      "startDate": "2026-01-01",
      "endDate": "2026-03-31",
      "placeOfService": ["11", "12", "02"],
      "status": "active",
      "notes": "Renewal requires updated treatment plan by 2026-03-15"
    }
  ],
  "page": 1,
  "pageSize": 50,
  "total": 1
}

ABA Sessions

POST /aba/sessions: Create or update an ABA session charge-ready record. Validates against authorizations, units, POS, and basic payer rules.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/aba/sessions \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "patientId": "pat_91c0ef",
    "renderingProviderId": "prv_rbt_2201",
    "supervisingProviderId": "prv_bcba_1043",
    "authorizationId": "auth_5a12f8",
    "payerId": "payer_bcbs_tx",
    "dateOfService": "2026-01-19",
    "placeOfService": "12",
    "cptCode": "97153",
    "modifiers": ["95"],
    "minutes": 120,
    "units": 8,
    "diagnosisCodes": ["F84.0"],
    "notes": "Discrete trial teaching; parent present; telehealth.",
    "telehealth": true,
    "referenceId": "ehr-session-78421"
  }'

Example response

{
  "sessionId": "ses_8df031",
  "chargeStatus": "validated",
  "warnings": [],
  "createdAt": "2026-01-19T19:05:12Z",
  "referenceId": "ehr-session-78421"
}

Claims

POST /claims: Assemble an 837P claim from validated ABA sessions. Supergood normalizes service lines and can route the generated file to the configured submission channel.

curl --request POST \
  --url https://api.supergood.ai/integrations/<integration_id>/claims \
  --header 'Authorization: Bearer <authToken>' \
  --header 'Content-Type: application/json' \
  --data '{
    "claimType": "837P",
    "payerId": "payer_bcbs_tx",
    "billingProvider": {
      "npi": "1234567890",
      "taxonomy": "Behavioral Health",
      "name": "Sunrise ABA Clinic",
      "billingAddress": {
        "line1": "200 Maple Ave",
        "city": "Austin",
        "region": "TX",
        "postalCode": "78701"
      }
    },
    "renderingProvider": {"npi": "1999999999"},
    "supervisingProvider": {"npi": "1888888888"},
    "serviceLines": [
      {"sessionId": "ses_8df031", "cptCode": "97153", "units": 8, "chargeAmount": 440.00}
    ],
    "submissionChannel": "clearinghouse",
    "referenceId": "billing-batch-jan19"
  }'

Example response

{
  "claimId": "clm_3b71a0",
  "status": "queued",
  "edi": {"format": "837P", "size": 43120},
  "submissionChannel": "clearinghouse",
  "createdAt": "2026-01-19T20:11:42Z",
  "reviewUrl": "https://download.aba-billing.example/signed/abc123...",
  "referenceId": "billing-batch-jan19"
}

Get full API Specs →

Technical Specifications

  • Authentication: Username/password with MFA (SMS, email, TOTP) and SSO/OAuth where enabled; supports service accounts or customer-managed credentials
  • Response format: JSON with consistent resource schemas and pagination
  • Rate limits: Tuned for enterprise throughput while honoring service scope and usage controls
  • Session management: Automatic reauth and cookie/session rotation with health checks
  • Data freshness: Near real-time retrieval of authorizations, sessions, and claim artifacts
  • Security: Encrypted transport, scoped tokens, and audit logging; respects customer entitlements and compliance requirements
  • Webhooks: Optional asynchronous delivery for claim generation, remittance updates, and denial events

Performance Characteristics

  • Latency: Sub-second responses for list/detail queries under normal load
  • Throughput: Designed for high-volume session import and batch claims pipelines
  • Reliability: Retry logic, backoff, and idempotency keys minimize duplicate actions
  • Adaptation: Continuous monitoring for UI/API changes with rapid adapter updates

Getting Started

  1. Schedule Integration Assessment

Book a 30-minute session to confirm your product mix, licensing, and authentication model.

  1. Supergood Builds and Validates Your API

We deliver a hardened adapter tailored to your workflows and entitlements.

  1. Deploy with Monitoring

Go live with continuous monitoring and automatic adjustments as systems evolve.

Schedule Integration Call →

Frequently Asked Questions

Q: What workflows can this integration cover?

Supergood supports eligibility/authorization tracking, session charge capture, claim assembly/submission, and remittance retrieval subject to your contracted services and entitlements. Coverage is finalized during integration assessment.

Q: How are MFA, SSO, and batch interfaces handled for automation?

We support username/password + MFA (SMS, email, TOTP) and can operate behind SSO/OAuth when enabled. For batch flows, we manage EDI timing windows, generate 837 files, and retrieve signed URLs or delivery confirmations programmatically.

Q: Can I generate claims directly from ABA sessions?

Yes. You can assemble 837P claims from validated sessions with payer-specific formatting. We can route submissions via your configured channel (payer portals or clearinghouse) and return statuses and artifacts for reconciliation.

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