Why Intake is the Most Important Revenue Cycle Stage

More revenue is lost at intake than at any other stage of the ABA revenue cycle. The decisions made in the first 1–2 weeks of a new client relationship — whether to verify eligibility thoroughly, whether to confirm ABA benefit coverage, whether to submit the authorization before the first session — determine whether you will be paid for the services you deliver.

The New Client Billing Checklist

Day 1: Insurance Verification

Step 1: Verify active coverage

Call the payor's provider line (or use the online portal) to verify:

  • Active coverage as of the anticipated start date
  • Member ID and group number
  • Plan type (HMO, PPO, EPO, Medicaid)

    • Step 2: Confirm ABA benefit coverage

    Not all insurance plans cover ABA. Specifically ask:

  • "Does this plan cover Applied Behavior Analysis services for autism spectrum disorder?"
  • "Are CPT codes 97151–97158 covered under this plan?"
  • "Is there a separate behavioral health benefit that covers ABA?"

    • Step 3: Identify deductible and out-of-pocket status

  • What is the annual deductible? How much has been met?
  • What is the out-of-pocket maximum? How much has been met?
  • What is the copay or coinsurance for behavioral health services?

    • Step 4: Identify coordination of benefits

  • Does the member have secondary insurance?
  • Which plan is primary?

    • Step 5: Verify your network status

  • Is your practice in-network for this specific plan?
  • (Note: Being in-network with Aetna does not mean you are in-network with every Aetna plan)

    • Day 2–5: Pre-Authorization Preparation

    Step 6: Confirm prior authorization requirement

    Most payors require prior authorization for ABA. Confirm:

  • Is prior authorization required for the initial assessment (97151)?
  • Is prior authorization required for ongoing therapy (97153, 97155)?
  • What is the authorization submission process (portal, phone, fax)?

    • Step 7: Gather required documentation

    Before submitting the authorization request, ensure you have:

  • ASD diagnosis (within the payor's validity window)
  • Functional Behavior Assessment (or schedule one)
  • Treatment plan template ready

    • Day 5–15: Authorization Submission and Tracking

    Step 8: Submit the authorization request

    Submit the prior authorization request as soon as the required documentation is complete. Do not wait until the first session.

    Step 9: Document the authorization request

    Record:

  • Date submitted
  • Submission method (portal, phone, fax)
  • Reference or confirmation number
  • Expected decision date

    • Step 10: Follow up if no response within 10 business days

    If you have not received an authorization decision within 10 business days, follow up with the payor.

    Before the First Session: Authorization Confirmation

    Step 11: Confirm authorization approval

    Before scheduling the first therapy session, confirm:

  • Authorization has been approved (not just submitted)
  • Authorization covers the correct CPT codes
  • Authorization start date covers the first session date
  • Authorization unit limit is sufficient for the planned schedule

    • Step 12: Configure authorization tracking

    Enter the authorization in your practice management system:

  • Authorization number
  • Authorized CPT codes and units
  • Authorization start and end dates
  • For Anthem: configure weekly unit tracking

    • The Most Expensive Intake Mistakes

    Mistake 1: Starting services before authorization is confirmed. This is the single most expensive intake mistake. Services delivered without a confirmed authorization are at high risk of denial, and retro-authorization requests are often denied.

    Mistake 2: Not confirming ABA benefit coverage. Some plans cover mental health services but specifically exclude ABA. Discovering this after 30 sessions of service results in a complete write-off.

    Mistake 3: Not verifying network status for the specific plan. Being in-network with a payor does not mean you are in-network for every plan that payor administers. Verify network status for the specific plan, not just the payor.