The Problem Most ABA Billers Don't Know About

When Anthem authorizes ABA services, the authorization letter specifies a weekly unit limit — not just a total authorization amount. This is fundamentally different from how every other major commercial payor structures ABA authorizations.

Example: Anthem authorizes 30 hours per week of ABA therapy (1,200 units per week of 97153). If your client misses a week of therapy due to illness, you cannot "make up" those units the following week by scheduling extra sessions. The weekly limit resets every Monday regardless of what was used the prior week.

This single policy difference is responsible for a disproportionate share of ABA claim denials at Anthem.

Why This Matters for Revenue

Consider a practice with 20 Anthem clients, each authorized for 25 hours/week. If each client averages even one missed week per quarter, that's 20 × 25 hours × 4 quarters = 2,000 hours of authorized but unbillable time annually. At an average rate of $15/unit (15-minute units), that's $120,000 in lost revenue per year — not from denials, but from the structural impossibility of making up missed sessions.

The denial risk is the other side: if a client attends extra sessions in a week to compensate for a prior week's absence, claims for units above the weekly limit will be denied as exceeding authorized amounts.

How to Identify Anthem Authorizations

Anthem authorization letters for ABA services will specify units in one of these formats:

  • "30 hours per week" or "120 units per week"
  • "Authorization for 1,560 hours (52 weeks × 30 hours/week)"

    • The weekly limit is the binding constraint. The total authorization amount is simply the weekly limit multiplied by the number of authorized weeks.

    Billing System Configuration

    Most practice management systems (CentralReach, Raven, Theralytics) allow you to configure authorization tracking at the weekly level. For Anthem authorizations, you must configure weekly unit tracking rather than total authorization tracking.

    Steps in CentralReach:

  • Open the authorization record
  • Under "Authorization Type," select "Weekly"
  • Enter the weekly unit limit for each CPT code
  • Set the authorization start and end dates

    • If your system does not support weekly authorization tracking, you will need to manually monitor weekly utilization against the Anthem authorization.

    Scheduling Strategies

    Given the weekly reset structure, the most effective scheduling strategies for Anthem clients are:

    1. Consistent weekly schedules: Build a fixed weekly schedule that uses the full authorized hours every week. Treat the weekly authorization like a weekly appointment slot.

    2. Proactive cancellation management: When a session is cancelled, immediately notify the billing team. Unlike other payors, there is no opportunity to recover cancelled Anthem units.

    3. Authorization buffer: When requesting Anthem authorizations, request slightly fewer hours than the client's clinical need to build in flexibility for weeks when the full schedule cannot be maintained.

    4. Telehealth as backup: For weeks when in-person sessions are disrupted, telehealth sessions can often be billed under the same authorization (verify with Anthem for the specific plan).

    What to Do When You've Exceeded Weekly Units

    If you've already submitted claims that exceed the weekly authorized units:

  • Do not resubmit immediately. Review the Anthem authorization letter to confirm the weekly limit.
  • Identify the overage: Determine which specific dates of service resulted in units exceeding the weekly limit.
  • Void or adjust the claims: File a corrected claim voiding the units that exceeded the weekly limit.
  • Appeal if appropriate: If you believe the clinical situation warranted the additional hours, file a concurrent review request with Anthem's behavioral health department.

    • The Bottom Line

    Anthem's weekly unit tracking is not a billing error — it is an intentional policy that requires a fundamentally different authorization management approach than any other major payor. Practices that treat Anthem authorizations like Aetna or UHC authorizations will consistently lose revenue and generate avoidable denials.

    Configure your practice management system correctly, train your scheduling team on the weekly reset, and build Anthem-specific workflows into your billing process.