Glossary · 38 terms

ABA billing glossary, in plain English.

The words your biller, your payers and your reports use, explained for clinic owners. Each term shows what it means, why it matters to you, and what it looks like on your weekly summary.

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All 38 terms, A to Z.

A

Stage 8 · Stable billing

Accounts receivable (AR)

Money you have billed for sessions but not yet collected, from payers or from families. It is usually grouped by how long it has been waiting.

Why it matters to you: The older a claim gets, the harder it usually is to collect, so AR is one of the clearest signs of how billing is going.
What this looks like on your weekly summary: Total AR split by payer and by aging bucket, with anything over 90 days called out by name.

Stage 7 · Payments + denials

Adjustment

A change to the amount owed on a claim line that is not a payment, such as the contractual write-down to your agreed rate or a write-off. Each adjustment should carry a reason.

Why it matters to you: Adjustments posted without a reason can hide money that should still be collected.
What this looks like on your weekly summary: Adjustments listed by reason, so a contractual write-down is never mixed up with money you gave up on.

Stage 8 · Stable billing

Aging bucket

A group of unpaid claims sorted by age, usually 0–30, 31–60, 61–90 and over 90 days from the date of service or the date billed.

Why it matters to you: Buckets show at a glance whether money is moving or getting stuck, and the oldest bucket is often closest to a filing deadline.
What this looks like on your weekly summary: A row per payer with a total in each bucket, so you can see which payer is slowing down.

Stage 7 · Payments + denials

Appeal

A formal request asking a payer to reconsider a denied or underpaid claim, usually with supporting records such as the authorization and session notes.

Why it matters to you: Each payer sets its own appeal deadline and steps, so a missed date can close the door on a claim you could have won.
What this looks like on your weekly summary: Open appeals with the payer, the date sent, the deadline and the next follow-up date.
In Texas: For Texas Medicaid fee-for-service, appeals are due within 120 days. Managed care plans set their own limits, so check each plan's manual.

Source:1 TAC §354.1003(opens in a new tab)

Stage 5 · Authorizations

Authorization (prior authorization)

The payer's approval, before services start, for a set of services, units and dates. Most ABA payers require it for treatment.

Why it matters to you: Sessions outside the approved dates or over the approved units are often not payable, even when the care was right.
What this looks like on your weekly summary: Active authorizations with units used and units left, and any that end in the next few weeks.
In Texas: Texas Medicaid requires prior authorization for all ABA services. Initial treatment can be authorized for up to 90 days, and the request must be made within 3 business days of the start-of-care date. Each managed care plan runs its own prior authorization.

Source:TMHP news, Feb 2025(opens in a new tab)

B

Stage 2 · Clinic setup

BAA (business associate agreement)

A contract required by HIPAA between a clinic and any outside company that handles its protected health information, such as a billing service, EHR or clearinghouse.

Why it matters to you: It should be signed before any PHI is shared, and it sets out how that information must be protected.
What this looks like on your weekly summary: You won't see it every week, but our process aims to have a BAA signed before any PHI moves, and on file if a payer or auditor asks.

Stage 4 · Benefits + intake

Benefits verification

Confirming what the family's plan covers for ABA: network status, deductible and cost share, limits, and whether prior authorization is needed.

Why it matters to you: It lets you tell families what they may owe before care starts, and it catches coverage gaps before sessions are booked.
What this looks like on your weekly summary: New clients with benefits confirmed, and any open questions with the person following up on each one.
In Texas: Texas's autism mandate applies to fully insured group plans when the diagnosis was made before the child's 10th birthday; those plans may limit ABA to $36,000 a year from age 10. Self-funded employer plans and individual plans may follow different rules, so ask whether the plan is a fully insured group plan or self-funded.

Source:Tex. Ins. Code §1355.015(opens in a new tab)

Stage 2 · Clinic setup

Billing provider

The person or organization on the claim that gets paid, usually shown with the clinic's Type 2 NPI and tax ID. It can be different from the provider who did the session.

Why it matters to you: If the billing provider on the claim doesn't match what the payer has on file, claims can be rejected or paid to the wrong place.
What this looks like on your weekly summary: Claims returned for provider mismatches, grouped by payer, so the record can be fixed once.
In Texas: For Texas Medicaid ABA, the LBA's individual NPI is both the rendering and the billing provider. Groups do not enroll.

Source:TMHP LBA enrollment(opens in a new tab)

C

Stage 3 · Payer credentialing

CAQH

An online profile, CAQH ProView, where providers keep their licenses, education, insurance and work history. Many commercial payers read it when credentialing.

Why it matters to you: An out-of-date or unattested profile can stall credentialing without anyone telling you why.
What this looks like on your weekly summary: Each provider's CAQH status and next re-attestation date, flagged when one is coming up.

Stage 7 · Payments + denials

Standard codes on a payer's remittance that explain what happened to each claim line. Claim Adjustment Reason Codes (CARC) say why an amount was adjusted or denied, and Remittance Advice Remark Codes (RARC) add detail.

Why it matters to you: The code points to the fix, so reading it correctly is the difference between a quick resubmission and a wasted appeal.
What this looks like on your weekly summary: Denials grouped by reason code each week, so repeating causes are visible and can be fixed upstream.

Clean claim

A claim with everything the payer needs and nothing that conflicts, so it can be processed without coming back for more information.

Why it matters to you: Clean claims tend to get paid faster and need less follow-up, which keeps cash flow steady.
What this looks like on your weekly summary: Claims sent this week, and how many came back as rejections or denials and why.

Stage 6 · Clean claims

Clearinghouse

A service that checks claims for format errors and passes them electronically from your billing system to payers, then brings back responses and remittances.

Why it matters to you: A claim stopped at the clearinghouse never reaches the payer, so its reports need to be worked every day.
What this looks like on your weekly summary: Clearinghouse rejections opened and fixed this week, with anything still waiting called out.

Stage 4 · Benefits + intake

Coordination of benefits (COB)

The rules that decide which plan pays first when a client has more than one, and how the second plan pays after. Medicaid usually pays last.

Why it matters to you: Billing the wrong plan first is a common reason for denials, and fixing it later takes time.
What this looks like on your weekly summary: Clients with more than one plan, which plan is primary, and any COB questions still open.

Stage 7 · Payments + denials

Corrected claim

A replacement for a claim the payer already received, sent to fix an error such as a wrong unit count, date or modifier. It is marked as a correction so it isn't treated as a duplicate.

Why it matters to you: Sending a fix as a brand-new claim can be denied as a duplicate and slow payment further.
What this looks like on your weekly summary: Corrected claims sent this week and what was fixed, so the same error can be stopped next time.

Credentialing

The payer's review of a provider's qualifications, licenses and history before letting them join its network. It usually ends with a contract and an effective date.

Why it matters to you: Until credentialing is done and you have an effective date, sessions with that payer's members may not be payable in network.
What this looks like on your weekly summary: In the reporting rhythm we set up, credentialing gets its own bi-weekly report: status by payer, last response and next action.

D

Stage 7 · Payments + denials

Denial

A claim the payer received and processed but decided not to pay, in full or in part, with a reason code explaining why.

Why it matters to you: Many denials can be fixed or appealed, but only if someone owns them before the deadline passes.
What this looks like on your weekly summary: New denials by reason and payer, who owns each one, the next action and the deadline.

E

Stage 3 · Payer credentialing

Effective date

The first date a payer will pay a provider for services, set in writing when credentialing or enrollment is approved.

Why it matters to you: A provider's start date is not the same as their effective date, and sessions before it may not be payable.
What this looks like on your weekly summary: Each provider and payer pair with its written effective date, or a note that it is still pending.

Eligibility

Whether a client's coverage is active on the date of service, with the plan and member details you expect.

Why it matters to you: Coverage can end or change without notice, and a session billed to an inactive plan is unlikely to be paid.
What this looks like on your weekly summary: In the reporting rhythm we set up, the front desk gets an eligibility report, run 7 days before each session as our process target, and the weekly summary shows anything still unresolved.

Stage 3 · Payer credentialing

Enrollment

Registering a provider with a payer, often a government program like Medicaid, so the payer knows who they are and can pay them. It often happens alongside or before credentialing.

Why it matters to you: Enrollment details become the record every claim is checked against, so a mistake here shows up on every claim.
What this looks like on your weekly summary: Enrollments in progress, what the payer is waiting on and the next follow-up date.
In Texas: Texas Medicaid enrollment runs through TMHP's PEMS and includes a site visit. After that, the provider contracts and credentials with each managed care plan in its service area.

Source:TMHP LBA enrollment(opens in a new tab)

ERA and EOB

The payer's explanation of how each claim line was paid, adjusted or denied. The ERA (electronic remittance advice) is the electronic file sent to your billing system, and an EOB (explanation of benefits) is the paper or PDF version.

Why it matters to you: This is where you learn what was actually paid and why, so it should be posted and read line by line.
What this looks like on your weekly summary: Payments received this week by payer, matched to the remittances that explain them.

L

Stage 3 · Payer credentialingTexas

LBA and LaBA

Licensed Behavior Analyst (LBA) and Licensed Assistant Behavior Analyst (LaBA), the two behavior analyst licenses TDLR issues in Texas under Occupations Code chapter 506. Licensing began in 2018.

Why it matters to you: Only an LBA enrolls with Texas Medicaid for ABA, so the LBA's license and enrollment are what every Texas Medicaid claim rests on.
What this looks like on your weekly summary: Each LBA's license expiry date and Texas Medicaid enrollment status, flagged well before a renewal is due.
In Texas: LaBAs and behavior technicians (RBT, BCAT or ABAT certified) cannot enroll with Texas Medicaid and work under LBA supervision. The LBA needs a current TDLR license that does not expire within 30 days of applying.

Source:TDLR behavior analysts at a glance(opens in a new tab)TMHP LBA enrollment(opens in a new tab)

M

Stage 3 · Payer credentialingTexas

Managed care organization (MCO)

A health plan that runs Medicaid benefits for its members on the state's behalf, with its own network, rules and prior authorization.

Why it matters to you: In Texas, enrolling with TMHP is not enough: you also contract and credential with each Medicaid managed care plan in your service area, and each one runs its own prior authorization, so check each plan's current instructions.
What this looks like on your weekly summary: A row for each Medicaid plan you work with: contract status, credentialing status and any open authorization issues.
In Texas: HHSC's January 2026 map lists the STAR Kids plans in each service area, for example Superior and Community First in Bexar, and Aetna and Cook Children's in Tarrant. STAR Health is Superior statewide. Wellpoint is the former Amerigroup.

Source:HHSC managed care service area map(opens in a new tab)

Modifier (HO, HN, HM)

A two-character code added to a procedure code to give more detail. In ABA, HO, HN and HM usually show the education level of the person who did the service: master's, bachelor's, and less than a bachelor's degree.

Why it matters to you: A missing or wrong modifier is a common, avoidable reason for a claim to be rejected or denied.
What this looks like on your weekly summary: Denials and rejections tied to modifiers, with the payer and code, so the claim rule can be fixed.
In Texas: Texas Medicaid requires HO on 97151, and HO or HN on 97155, 97156 and 97158. HO, HN or HM may be added to 97153 and 97154. Modifier 95 is required for telehealth.

Source:TMPPM Children's Services Handbook(opens in a new tab)

N

Stage 2 · Clinic setup

NPI (Type 1 and Type 2)

The 10-digit National Provider Identifier from NPPES. Type 1 belongs to an individual provider, like a BCBA, and Type 2 belongs to an organization, like your clinic.

Why it matters to you: Putting the wrong NPI in the wrong place on a claim is a quiet, repeating cause of rejections.
What this looks like on your weekly summary: Usually nothing, which is the goal; if an NPI mismatch causes rejections, it is listed with the fix.

P

Stage 7 · Payments + denials

Payment posting

Recording each payment, adjustment and denial from the remittance against the right claim line in your billing system.

Why it matters to you: If posting is late or wrong, AR looks better or worse than it really is and denials can be missed.
What this looks like on your weekly summary: Payments posted this week by payer, and any remittance that couldn't be matched to a claim.

Stage 3 · Payer credentialingTexas

PEMS

TMHP's Provider Enrollment and Management System, the online system used to enroll with Texas Medicaid. Enrollment includes a site visit.

Why it matters to you: It is the first step before you can contract with Texas Medicaid managed care plans, so it sets the pace for everything after it.
What this looks like on your weekly summary: Your PEMS application status, the last update and what TMHP is waiting on.

Source:TMHP LBA enrollment(opens in a new tab)

PHI (protected health information)

Health information that can identify a person, such as a client's name, date of birth, member ID, diagnosis or session notes. HIPAA sets rules for how it is used and shared.

Why it matters to you: Every vendor and channel that touches PHI needs the right protections, starting with a signed BAA.
What this looks like on your weekly summary: Our process aims to share reports only through secure channels, and to use labels like Client A or an authorization number wherever a name isn't needed.

Stage 6 · Clean claims

Place of service (POS)

A two-digit code on the claim for where the session happened, such as 11 for an office, 12 for the client's home or 03 for a school. Telehealth has its own codes.

Why it matters to you: A place of service that doesn't match the note or the authorization can lead to a denial or the wrong payment.
What this looks like on your weekly summary: Claims returned for place-of-service issues, with the payer and the fix.

R

Stage 5 · Authorizations

Reauthorization and extension

A new request to continue services after an authorization ends, or to add time or units to it. Most payers set a window for when the request can be sent.

Why it matters to you: If a renewal is sent late, sessions can fall into a gap with no authorization behind them.
What this looks like on your weekly summary: Authorizations ending soon, whether the renewal has been sent, and the date it is due.
In Texas: Texas Medicaid allows one 90-day extension of the initial authorization, requested within the 30 days before the period ends. Recertification periods are 180 days, requested no earlier than 60 days before expiry. Since April 1, 2025, extensions no longer need the prescriber's signature.

Source:TMHP news, Feb 2025(opens in a new tab)

Stage 6 · Clean claims

Rejection

A claim stopped before the payer processed it, usually by the clearinghouse or the payer's front-end check, because of a format or data error.

Why it matters to you: A rejected claim was never received for payment, so the filing clock keeps running until it is fixed and resent.
What this looks like on your weekly summary: Rejections opened and fixed this week, and any still waiting with their age.

Stage 2 · Clinic setup

Rendering provider

The individual who actually provided the service, shown on the claim with their Type 1 NPI.

Why it matters to you: Payers check that the rendering provider is credentialed with them and allowed to provide that service.
What this looks like on your weekly summary: Claims returned because a rendering provider isn't credentialed or active with that payer.
In Texas: For Texas Medicaid ABA, the LBA's individual NPI is both the rendering and the billing provider. LaBAs and behavior technicians work under LBA supervision and cannot enroll.

Source:TMHP LBA enrollment(opens in a new tab)

S

Stage 1 · DreamTexas

STAR Kids

A Texas Medicaid managed care program. HHSC's service area map shows which plans offer STAR Kids in each area, for example Texas Children's, United and Wellpoint in Harris.

Why it matters to you: The plans in your service area decide which contracts and credentialing you will need for Texas Medicaid families.
What this looks like on your weekly summary: Your contract and credentialing status with each STAR Kids plan in your area.

Source:HHSC managed care service area map(opens in a new tab)

T

Stage 2 · Clinic setup

Taxonomy code

A code that describes a provider's type and specialty, chosen when the NPI is set up in NPPES. Behavior analysts have their own taxonomy code.

Why it matters to you: If the taxonomy on the claim doesn't match NPPES and the payer's record, claims can be rejected.
What this looks like on your weekly summary: Usually nothing; if a taxonomy mismatch causes rejections, it is listed with the record that needs updating.

THSteps-CCP

Texas Health Steps–Comprehensive Care Program, the Texas Medicaid benefit that covers ABA for dates of service on or after February 1, 2022.

Why it matters to you: It covers members age 20 and under with an autism diagnosis from a comprehensive evaluation, made or reconfirmed within 3 years, so that has to be on file.
What this looks like on your weekly summary: Texas Medicaid clients whose diagnostic evaluation needs reconfirming soon, flagged before it affects authorizations.

Source:TMPPM Children's Services Handbook(opens in a new tab)

Stage 6 · Clean claims

Timely filing

The deadline for a payer to receive a claim, counted from the date of service. Each payer sets its own.

Why it matters to you: Claims that miss timely filing are usually denied for good, even when the care was approved and documented.
What this looks like on your weekly summary: Claims getting close to a payer's filing limit, called out before the deadline.
In Texas: Texas Medicaid fee-for-service claims are due within 95 days of the date of service. Managed care plans set their own limits, so check each plan's manual.

Source:1 TAC §354.1003(opens in a new tab)

TMHP

Texas Medicaid & Healthcare Partnership, which runs Texas Medicaid provider enrollment through PEMS and publishes the Texas Medicaid Provider Procedures Manual (TMPPM).

Why it matters to you: TMHP's manual and notices are where Texas Medicaid ABA rules are set out, so they are the first place to check when a rule changes.
What this looks like on your weekly summary: Any TMHP notice that changes how your Texas Medicaid claims or authorizations work, with what it means for you.

Source:TMPPM Children's Services Handbook(opens in a new tab)

Stage 3 · Payer credentialingTexas

TPI (Texas Provider Identifier)

The identifier Texas Medicaid issues to enrolled providers; check TMHP for current use.

Why it matters to you: It is part of your Texas Medicaid enrollment record, so keep it with your NPI and enrollment details.
What this looks like on your weekly summary: Kept on your provider record, not on the weekly summary, unless it is part of an open enrollment question.

U

Stage 6 · Clean claims

Units (15-minute units)

Most ABA treatment codes are billed in units of 15 minutes, so a one-hour session is usually 4 units. Payers set rules for partial units, so check each payer.

Why it matters to you: Units have to match the session note and fit inside the authorization, or the claim may be cut back or denied.
What this looks like on your weekly summary: Units used against units authorized, by client label and code, with any authorization close to running out.
In Texas: In Texas Medicaid, one unit is 15 minutes. Direct treatment (97153, 97154, 97155 and 97158 combined) is capped at 8 hours a day unless medical necessity supports more.

Source:TMPPM Children's Services Handbook(opens in a new tab)

Checked November 2, 2026. Billing4ABA is a billing service, not legal counsel. Payer rules change; confirm with the payer and the cited source before acting.

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