Revenue Cycle Management built exclusively for boutique ABA therapy agencies.
We help boutique ABA agencies (4–10 BCBAs) cut denials, recover AR, and unlock the analytics their software never gave them. PMS-agnostic. Founder-direct service. Bilingual English & Spanish.
Denials
24.6%
+3.1 vs benchmark
AR > 90d
$18.4k
7 claims at risk
Clean rate
75.4%
+2.0 this month
Top denial reasons · trailing 30d
synthetic data
AR aging trend · 90 days
ImprovingThe reality
Authorizations expire mid-treatment. Modifiers stack in confusing combinations. Payers reinterpret medical-necessity rules quarter to quarter. The denial rates speak for themselves. And most enterprise billers treat ABA as a footnote.
That's the gap. That's what we're built for.
In-network denial rate
19%
2024 ACA marketplace
KFF analysis of CMS data, 157 insurers. ABA practices commonly report higher. The gap is what we quantify in your Audit + Playbook.
Modifier matrix
8+
Combinations to manage
HM · HN · HO · HP (supervision tier) + modifier 95 (telehealth) + state-specific U-modifiers. One mismatch denies.
CPT scope
97151–58
Codes anchoring ABA
Each with its own auth, units, and credentialing rules per payer.
Florida Medicaid
SMMC 3.0
Effective Feb 1, 2025
Behavior Analysis transitioned to managed care. Providers must be in-network with each MCO.
Sources: AMA Current Procedural Terminology (CPT®) Manual (codes 97151–97158); CMS HCPCS Level II Modifier reference; FL AHCA Statewide Medicaid Managed Care 2025–2030 Plans documentation; KFF Claims Denials and Appeals in ACA Marketplace Plans 2024.
How we're different
Enterprise billers treat small agencies as ticket queues. We're built around the practices most firms ignore. With the analytics depth most firms don't have.
We don't just process claims. We engineer revenue. Custom Power BI dashboards for denial analysis, payer performance, BCBA productivity, and AR aging segmentation. Built on a foundation in business intelligence, not just billing.
No account managers. No tickets to log. No "let me check with the team." When you call Cleared RCM, you talk to the person doing the work. The same person who reads your contracts, builds your dashboards, and submits your appeals.
One niche, deep expertise. CPT 97151–97158, prior-auth strategy by MCO, modifier matrices, telehealth rules, supervision documentation. We live in your codes. Not 40 other specialties at once.
Built for the Latino-serving practices other firms ignore. Founder-led, native-Spanish communication with your providers, families, and front-desk teams. Especially relevant for Florida and Texas markets.
How we work
Every relationship starts with an audit. Not a contract. We earn the next step.
Free initial review of AR aging, denial codes, payer mix, and auth lapses. We tell you what's broken before you sign anything.
We propose Full Service (5% of net collections, Power BI included) or Audit + Playbook (one-time diagnostic). Whichever fits your moment.
Eligibility, prior auth, claim submission, payment posting, denial management, appeals, AR follow-up. Daily ops, weekly check-ins.
Live Power BI dashboards via secure link with your data filtered to your view. Denial trends, payer performance, AR aging, BCBA throughput. Monthly executive review.
Built on data
Every Cleared RCM client gets live Power BI dashboards purpose-built for ABA. Not vanity charts. The four views that actually move revenue.
Denial Analysis · Sample Practice
Submitted
$428k
▲ 12.4%
Denied
$76k
17.8% rate
Recovered
$54k
71% recovery
Days in AR
31.4
▼ 4.2 days
Claim outcomes · last 6 months
Reasons, payers, providers. Find the root cause before it repeats next week.
0–30, 31–60, 61–90, 90+. Segment by payer so you know who's stalling.
Billable vs documented hours, per supervisor. Spot under-utilization and burnout.
Days-to-pay, denial rate, paid-per-unit. Negotiate with data, not anecdotes.
A note from the founder
"Every BCBA got into ABA because they cared about kids. Nobody got in because they love modifier matrices. That's where we come in."
I'm Alvaro. I built Cleared RCM because boutique ABA practices were paying enterprise-sized denial rates without the back office to push back. The numbers move when someone reads the contracts, builds the dashboards, and picks up the phone. Cohort 1 starts now.
We won't pretend to have ten years of case studies. We will tell you exactly what we'd do, prove it on an audit, and earn the engagement.
We're accepting a small first cohort of Florida-based ABA agencies for free initial reviews. No commitment, no pitch deck. Just data.
Typical response within one business day · Free Initial Review, no contract