Submitting a corrected claim is often the fastest and most efficient way to resolve a denial. To support timely processing and reduce avoidable delays, we want to highlight a few key reminders for corrected claims submissions. Corrected claims should be clearly identified using the appropriate frequency code, which allows our system to recognize the submission as a replacement to a previously processed claim rather than a duplicate. Providers should also reference the most recently processed claim when submitting a corrected version. This ensures the corrected claim aligns with the latest adjudicated information and prevents conflicts between multiple submissions. Timely filing and faster resolution Including all updated details—such as revised billing codes, modifiers, dates of service, or supporting documentation—helps our team review and reprocess the claim efficiently. Submitting a corrected claim rather than a new or duplicate claim also helps Initial evaluation (CPT code 97151): Submit the completed evaluation and treatment plan. For the first 90 days of treatment, a signed physician referral is also required. The referral should clearly list the recommended frequency and duration of services. 90-day extension: Please include attendance logs for both the child and the parent or caregiver, along with a brief progress summary that describes how treatment is going so far. 180-day re-evaluation: Every 180 days, a full re-evaluation and updated treatment plan are needed. Both documents must be signed and dated by the licensed behavior analyst (LBA) and by the parent or caregiver. stay informed Best practices for submitting corrected claims ABA SERVICES Keeping treatment moving without delays bridge timely filing, as corrected claims are considered part of the original claim’s life cycle. Duplicate submissions, however, may result in denials and do not extend timely filing limits. We also encourage Providers to submit a corrected claim instead of an appeal when the issue is related to coding, modifiers, or missing information. Appeals are intended for disputing an adjudication decision, while corrected claims allow the claim to be reprocessed with updated data—often resulting in faster resolution. While we cannot advise on how to bill, our Claims Department is available to explain how corrected claims adjudicate based on what is submitted. Applied behavior analysis (ABA) services are critical for Texas Medicaid members with autism spectrum disorder. To keep care running smoothly and to avoid delays in claims, please make sure the following items are submitted at each stage of treatment. Submitting these items on time helps prevent denials and keeps therapy consistent for your patients. If you have any questions about the documentation requirements, please contact our Provider Services team for direct assistance. 3
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