Practice Overview
A small but ambitious ABA therapy provider in Texas delivers individualized behavioral therapy for children and teens with Autism Spectrum Disorder (ASD). With a tight-knit team of 7 BCBAs and 3 RBTs, the clinic supports around 70-80 families every month, and demand keeps climbing.
Their waiting list is overflowing with families desperate for help. Their expansion plan? Bring in 20 new children every month to meet the need in their community. But their ability to grow depended on one thing: getting ahead of eligibility backlogs that threatened to choke their revenue and stall their mission.
The Problem
The practice’s billing team was stuck in a reactive cycle:
- Eligibility and benefit verifications were handled at intake or whenever a crisis popped up.
- Payer rules changed constantly, but the team didn’t have a reliable system to catch those changes before they turned into denied claims.
- They tracked everything manually across scattered spreadsheets, sticky notes, and email threads.
At one point, they had over 45 children on the schedule whose coverage hadn’t been re-verified. That meant thousands of dollars in sessions at risk of being denied, exactly the kind of revenue hit that makes hiring more staff and opening slots for waiting families feel impossible.
AnnexMed’s Findings
- Eligibility checks were backward-looking instead of forward-looking, no consistent timeline, no safety net.
- Tracking was manual and disjointed; errors and missed updates were a daily risk.
- The billing team didn’t have visibility into eligibility status until after claims were denied.
The 2-Step Fix
Step 1: Centralized, Live Eligibility Tracker
AnnexMed implemented a real-time tracker that pulled in up-to-date benefit information for every child. No more guessing, no more buried spreadsheets.
Step 2: A Proactive, Predictable Workflow
We rebuilt the workflow so that eligibility was verified 72 hours before every new authorization cycle and before sessions were delivered. The billing team got real-time status updates so they knew, with certainty, whether a session would get paid.
The 4-Week Transformation
- Week 1: Full patient roster audit by dedicated resource; admin team trained on new tracker
- Â Week 2: 2 AnnexMed specialists cleared 50% of the backlog
- Â Week 3: Eligibility status synced with billing; auto alerts for expiring authorizations
- Week 4: Final QA; daily live reports keep backlog down as the clinic expands
Results
- 40% reduction in eligibility backlog (45 → 27 pending files)
- 18% boost in clean claims rate
- Payments are collected an average of 21 days faster
- Admin team saved 5–7 hours weekly, time now used to onboard families from the waiting list
- Ready to bring in 20 new kids each month, confident that every session is covered
