Client Impact: $500,000 in Paid Claims | Resolution Time: 4 Months
Industry Impact: Statewide System Fix for All ABA Medicaid Providers
The Challenge
In Indiana, ABA providers faced a critical billing disruption when CPT 0373T—a Category III code essential for adaptive behavior treatment with protocol modification—was excluded from Indiana Medicaid’s provider-to-procedure code linkage system. This oversight resulted in a total breakdown of claim processing for this code, affecting all Medicaid ABA providers across the state. Every submitted 0373T claim was denied, regardless of medical necessity or prior authorization.
The Advocacy
Missing Piece ABA Billing took immediate action on behalf of our client by filing a formal appeal for the denied claims. While this appeal was successful, and the initial claims were overturned and paid, the systemic issue remained unresolved. Claims for CPT 0373T continued to be denied for all providers.
Recognizing that a broader resolution was necessary, Missing Piece ABA Billing escalated the matter by filing a formal dispute directly with Indiana Medicaid. We used the evidence of the paid, overturned claim from the appeal to clearly illustrate the system error and to advocate for an update to Medicaid’s internal code mapping.
The Outcome
After months of persistence and detailed documentation, Indiana Medicaid acknowledged the issue and updated its system to link CPT 0373T to ABA provider types properly. Not only were our clients’ claims reprocessed and paid—resulting in $500,000 in recovered revenue—but Indiana Medicaid reprocessed all previously denied 0373T claims for providers statewide.
The Bigger Picture
This case wasn’t just a win for our client—it fixed a fundamental system error that impacted the entire network of ABA providers billing Indiana Medicaid. Thanks to Missing Piece ABA Billing’s tenacious and informed approach, providers across the state now receive proper reimbursement for this vital service code.
Conclusion
At Missing Piece ABA Billing, we don’t stop at individual appeals. We uncover root causes, challenge flawed systems, and push for payer accountability to protect not only our clients but the provider community at large.