Foundations · Stage 2 · Clinic setupPrintable checklistTexas

Pre-first-claim readiness checklist

Claim one only goes through when the same names, numbers and codes appear everywhere: the IRS, NPPES, CAQH, each payer, your EHR and your clearinghouse. Work through this list before you schedule the first billable session.

Checked November 2, 2026 · Billing4ABA · Billing built only for ABA.

Tick each line only when you can point to the document or screen that proves it. Write the date next to it.

Entity and identity

  • Legal entity formed, with the exact legal name written down.Spell it the same way on every form: IRS, NPPES, CAQH, payer contracts and the bank.
  • EIN issued, and the IRS confirmation letter saved where you can find it.
  • Business bank account in the entity's name, ready for payer EFT enrollment.
  • Physical service address matches across NPPES, CAQH, payer files and the EHR.

NPIs and taxonomy

  • Type 1 (individual) NPI for each BCBA or LBA.
  • Type 2 (organization) NPI for the clinic, if you will bill commercial plans as a group.Texas Medicaid is different: the LBA's individual NPI is both the rendering and the billing provider, and groups do not enroll.
  • Taxonomy chosen and the same in NPPES, CAQH, payer files and the EHR.Behavior analyst taxonomy 103K00000X appears in TMHP's LBA enrollment document.
  • NPPES record shows the current legal name, address and contact person.

Credentials

  • CAQH profile complete, attested, documents uploaded and each payer authorized to view it.Put the next re-attestation date on the calendar.
  • TDLR license active for each LBA, with the expiry date on the calendar.Texas Medicaid: the license must not expire within 30 days of applying.
  • BACB certification current for each BCBA and RBT.
  • Professional liability certificate on file and uploaded where payers ask for it.

Payer enrollment, payer by payer

  • For each payer: status, contract signed, provider ID and the effective date in writing.
  • Texas Medicaid: TMHP enrollment through PEMS complete, including the site visit.
  • Texas Medicaid: contracted and credentialed with each managed care plan you will serve.Each plan runs its own prior authorization. Check each plan's current instructions.
  • TRICARE: TriWest ACD enrollment done and this year's ACD provider education complete.
  • No billable sessions scheduled for any payer before its written effective date.

EHR and practice management

  • Billing provider and rendering providers set up with the right NPI and taxonomy for each payer.
  • Service codes you will use are loaded, with 15-minute units for the timed ABA codes.
  • Modifiers mapped per payer.Texas Medicaid modifiers are on the Texas Medicaid ABA desk card.
  • Place of service codes set per location (for example office, home, school, telehealth), checked against each payer's rule.
  • Payer list built with the correct payer IDs and claim addresses.
  • Session note template captures start and stop times, provider, location and service.

Clearinghouse, money and agreements

  • Clearinghouse account live and enrolled for claims with each payer that requires it.
  • ERA (electronic remittance) and EFT (direct deposit) enrollment started for each payer.
  • Payer IDs in the clearinghouse match the EHR payer list.
  • Fee schedule loaded for each payer, so you can spot underpayments.
  • Business Associate Agreement signed with every vendor that touches PHI: EHR, clearinghouse, billing service.

Test claim plan

  • Pick one payer and one session for the first claim.
  • Submit, then check the clearinghouse acceptance report the next business day.
  • Confirm the payer received it (portal or claim status).
  • When the first remittance arrives, compare it line by line with the fee schedule.
  • Name who fixes rejections, and by when.

Sources

  1. [1]TMHP: Licensed behavior analyst enrollment (PDF)
  2. [2]1 TAC §354.5011
  3. [3]TDLR: Behavior analysts at a glance (PDF)
  4. [4]NPPES (CMS): apply for or update an NPI
  5. [5]CASP / txABA webinar on Texas Medicaid ABA (2022). Check each plan's current instructions.
  6. [6]TriWest: Autism Care Demonstration for providers

Checked November 2, 2026. Payer rules change; confirm with the payer and the cited source before acting.

Billing4ABA is a billing service, not legal counsel. Payer rules change; confirm with the payer before acting.

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