Billing & Claims
Coming soonABA billing and claims software built on the authorization-to-claim chain
Authorization → ScheduleBooking → SessionInstance → SessionNote → Claim. Eligibility is live today; notes and claims are built into the architecture and rolling out in product releases.
- 1
Eligibility
LiveBCBS NC · ABA covered · prior auth
- 2
Authorization
Roadmap97153 · 240 units · exp 06/30/2026
- 3
ScheduleBooking
RoadmapMon/Wed/Fri 3:00–5:00 · RBT KP
- 4
SessionInstance
RoadmapWed Mar 11 · 3:00–5:00 · completed
- 5
SessionNote
Roadmap8 units · signed by KP · 5:42 PM
- 6
Claim
Roadmap97153 × 8 units × $68.40 = $547.20
What is TargetFlo Billing & Claims?
TargetFlo Billing & Claims is ABA billing and claims software that treats a claim as the last link in a chain — authorization, booking, session, and signed note — rather than a form filled in from memory. The chain starts with live insurance eligibility at intake and runs through roadmap scheduling, session notes, and claims submission, all on the same client record.
Built into the architecture — rolling out in product releases
The ABA revenue path
Five records, one chain
Every claim TargetFlo produces can be traced back to a specific session, a signed note, and the authorization it drew units from.
- 01
Authorization
Approved units per CPT code
- 02
ScheduleBooking
Recurring slots
- 03
SessionInstance
Calendar session
- 04
SessionNote
Clinical documentation
- 05
Claim
Billable units × rate
Codes
ABA CPT codes TargetFlo models (97151–97158, H0032)
Each code carries a typical provider type. Scheduling uses it to enforce credentials; billing uses it to compute units × rate.
| CPT code | Service | Typical provider |
|---|---|---|
| 97151 | Behavior Identification Assessment | BCBA |
| 97152 | Supporting Assessment | RBT |
| 97153 | Direct ABA Therapy | RBT |
| 97155 | Protocol Modification / Supervision | BCBA |
| 97156 | Parent/Caregiver Training | BCBA |
| 97158 | Group ABA | RBT |
| H0032 | BIP/POC Development (NC Medicaid) | BCBA |
Rates and unit definitions vary by payer and state. TargetFlo stores contracted rates per payer and code so the claim math is yours, not a default. Read CPT codes for ABA therapy explained.
Capabilities
What is live and what is coming
One live item starts the chain today. The rest are labeled Coming soon and ship as releases on the same data model.
Eligibility at intake
Real-time 270/271 checks run in the Insurance stage so coverage and prior-auth requirements are known before the first session.
Authorization management
Approved units per CPT code, effective and expiry dates, and remaining balance — the number every booking checks against.
Authorization-linked sessions
Every SessionInstance references the authorization it draws from. Sessions without coverage are flagged before they happen.
Session notes
Clinical documentation attached to the session it describes, signed by the rendering provider, ready to support the claim line.
Units × rate
Claims are computed from documented units and the contracted rate per CPT code, not re-keyed from a paper log.
Claims submission
Submit claims with the session, note, and authorization linked — so denials can be traced to a specific gap in the chain.
Live today
Live todayEligibility feeds billing from the first touch
Billing problems usually start at intake: a plan without an ABA benefit, a prior-auth requirement nobody noticed, a deductible that changes the family's decision. TargetFlo runs the 270/271 check in the Insurance stage so the answer is on the client record before anyone schedules.
- Payer, plan, effective date, copay, deductible, and ABA benefit captured per client
- Prior-authorization requirement surfaces before the Pending Authorization stage
- Results attach to the client record and carry forward into authorization management
- Stedi-compatible connection; no re-keying from a payer portal
Coverage active
- Payer
- Blue Cross NC
- Plan
- PPO — Employer
- Effective
- 01/01/2026
- Copay
- $30 / visit
- Deductible met
- $1,120 / $2,000
- ABA benefit
- Covered · prior auth
Authorization path
- Physician verified
- Auth submitted
- Pending
- Authorized
Why the chain matters
Coming soonAuthorization-linked scheduling prevents unbillable sessions
An unbillable session is one that was delivered but cannot be claimed — because the authorization had expired, the units were exhausted, or the wrong credential rendered it. Every one of those failures is knowable before the session if the schedule is linked to the authorization.
- Units remaining per CPT code are checked when the booking is created, not when the claim is denied
- Authorization windows are enforced on the calendar; sessions outside them are flagged
- Credential rules (RBT for 97153, BCBA for 97155/97156) are applied at scheduling
- A missing or unsigned SessionNote blocks the claim line instead of producing a rejected one
- 1
Eligibility
LiveBCBS NC · ABA covered · prior auth
- 2
Authorization
Roadmap97153 · 240 units · exp 06/30/2026
- 3
ScheduleBooking
RoadmapMon/Wed/Fri 3:00–5:00 · RBT KP
- 4
SessionInstance
RoadmapWed Mar 11 · 3:00–5:00 · completed
- 5
SessionNote
Roadmap8 units · signed by KP · 5:42 PM
- 6
Claim
Roadmap97153 × 8 units × $68.40 = $547.20
Roadmap releases
Session notes and claims submission
Two releases complete the chain. Both are labeled Coming soon and attach to the sessions and authorizations already in your TargetFlo account.
Session notes
Clinical documentation attached to the SessionInstance it describes. Notes capture the rendering provider, start and end time, units delivered, and the provider's signature. A session without a signed note cannot produce a claim line.
Claims submission
Claims are generated from documented units multiplied by the contracted rate for each CPT code, then handed to your clearinghouse or payer connection with the authorization, session, and note linked — so any denial points to a specific gap.
Read the full workflow: Authorization to claim — the ABA revenue cycle explained.
FAQ
Billing & claims FAQs
Straight answers on what is live, what is roadmap, and how the chain fits together.
Related features
Get the billing chain right from intake
Book a demo. We show live eligibility at intake and walk through how authorization management, session notes, and claims release on the same records.