ABA Payer Rules and Billing Settings: A 12-Point Setup Checklist
Everything to set up before billing ABA claims: billing NPI, taxonomy, EIN and address once per organization, then per payer the rates, unit rounding, credential and telehealth modifiers, place of service, code mapping and timely filing.
Most rejected ABA claims trace back to setup. TargetFlo splits it into Billing settings (once per organization) and Payer rules (once per payer). Here's the checklist.
Billing settings — once per organization
- Billing name and NPI — the NPI is checked for a valid check digit.
- Taxonomy code.
- EIN — encrypted; only the last four digits are shown.
- Billing address (9-digit ZIP), optional pay-to address, and a billing contact and phone.
- Batching — weekly claims per client, insurance, payer and renderer, or one claim per session.
- Review mode — review every claim, or only flagged ones (live payers always need a person's approval).
- Default timely filing days.
Payer rules — once per payer
- Rates — contracted rate per unit for each code (97151–97158, 0362T, 0373T, H0032).
- Unit rounding — CMS 8-minute, exact 15, or round down.
- Modifiers — credential modifiers (HM, HN, HO by default), the telehealth modifier (95 by default), and the renderer roles allowed.
- Place of service — clinic 11, home 12, school 03, community 99, telehealth 02 by default; plus a code map if the payer wants different codes.
- Timely filing days, rendering-NPI requirement, ERA enrollment, and shadow or live.
New payers get these defaults the first time they appear, in shadow mode — so nothing is sent until you go live.
Related: Why ABA charges get held · ABA CPT codes guide · Billing & Claims
- ABA billing setup checklist
- ABA payer rules
- ABA modifiers HM HN HO
- CMS 8 minute rule ABA
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