$197.9M+
Four-state Medicaid audit findings
HHS OIG's ABA/autism audit series has reported at least $77.8M in Colorado, $56M in Indiana, $45.6M in Maine, and $18.5M in Wisconsin improper payments.
HHS OIGABA audit exposure monitoringSee your audit risk
See your audit risk
before a payer does.
Claimo watches billing patterns, authorization utilization, and documentation across your practice — Medicaid and commercial — and names the exposure that leads to clawbacks, pre-payment reviews, and audits.
PHI stripped before AIHIPAA-safeSOC 2 in progress
Practice risk score
LIVE · synced 12s ago42
16 this monthout of 100
0 · healthy50100 · risk
30-day trend 16 · prior 58
What the score is built on
Documentation
Note quality, supervision language, session detail
Billing patterns
Credential, modifier, ratio, and volume outliers
Cross-document
Claim-to-note-to-authorization consistency
Utilization
Burn rate, auth coverage, hours vs. peers
Billing patterns
Credential mismatches, supervision ratios, and uniform-hour outliers across providers.
Authorization utilization
CPT-level burn rate, expiration timing, and units billed beyond approved coverage.
Practice risk score
A 0–100 operating view with top drivers, dollar exposure, and month-over-month movement.
Built for ABA practices on Medicaid, commercial, or both
Pre-launchOnboarding select ABA practicesMedicaid + commercial payersClaims + notes + authorizationsPHI stripped before AIHIPAA-safeSOC 2 in progressSingle- and multi-sitePre-launchOnboarding select ABA practicesMedicaid + commercial payersClaims + notes + authorizationsPHI stripped before AIHIPAA-safeSOC 2 in progressSingle- and multi-site
How it works
Claimo monitors your practice the way a payer does.
Individual note errors are symptoms. The billing pattern is what gets a practice audited. Claimo turns those patterns into a review queue your team can act on.
01
Upload the records that drive audit exposure.
Claimo is built around the documents ABA teams already work from: claims, session notes, authorizations, and payer rules. PHI is stripped before AI review.
02
Reconcile claims to notes and authorizations.
Each billed line is checked against its session note and authorization coverage, so missing documentation, CPT/unit mismatches, and authorization gaps are visible together.
03
Prioritize the dollars and drivers at risk.
The dashboard rolls those findings into a Practice Risk Score, billed dollars at risk, factor breakdowns, and line-level review paths your team can act on.
Product
What Claimo watches across your practice.
Three operating views of one monitoring system: practice-level exposure, authorization coverage, and line-level claim support.
01Command Center
One number for the audit risk in your practice today.
A 0–100 Practice Risk Score rolled up from documentation, billing patterns, cross-document consistency, recurrence, and utilization — with the dollars at risk and the reasons behind them in the same view.
- Live score that moves as new claims, notes, and authorizations are processed
- Top risk drivers name the exact finding, the documents behind it, and how many points it adds
- Active alerts feed surfaces critical items — expiring auths, credential mismatches, pattern outliers
- Factor-level breakdown across the five risk dimensions, with the score's history kept on record
Practice risk score
38/ 100
Moderate risk-9 vs last month
Based on 1184 documents this month. Lower is better — zero means nothing flagged.
Low riskModerateHighCritical
Billed $ at risk
$189,500
11% of billed dollars have documentation, authorization, or billing-support exposure.
Missing documentation$27,600
No session note, or documentation too ambiguous to support the billed service.
Documentation quality flags$104,800
The note exists, but support is thin: mismatch, sparse detail, no lesson-plan link, or copy-paste language.
Authorization gap$32,400
The billed date or service is not covered by the authorization on file.
Multiple issues$24,700
More than one exposure reason, such as documentation quality plus an authorization gap.
Review line-level claims
03Claim reconciliation
Every billed line, reconciled to its note and its authorization.
Claimo links each claim service line to its session note and to the authorization that covers the date of service. The result is a simple review view showing what is supported, what is mismatched, and which dollars need attention.
- Claim lines matched to SOAP notes by date, service code, units, and client
- Authorization status shown beside each billed service line
- Billed dollars at risk summarized at the claim and batch level
- PHI stripped before any model review or audit-support summary
Claim reconciliation
PHI strippedClaims matched to notes and auths
Batch Apr 2026: 428 claims, 1,842 service lines, 96 clients.
Claims checked
428
1,842 billed service lines
Billed at risk
$52.8K
74 lines across 21 claims
Clean match
92%
Claim, note, and auth aligned
Claim CF-2087
Client 4281 · Aetna · $612 billed on 3 lines
DOS 04/14CPT 971538 units
$240
Note: MatchedAuth: Covered
DOS 04/14CPT 971554 units
$232
Note: Code mismatchAuth: Covered
DOS 04/16CPT 971562 units
$140
Note: MatchedAuth: No authorization
97155 credential mismatch
Claim line lists RBT rendering provider; policy expects BCBA/BCaBA for protocol modification.
Auth gap on caregiver training
97156 appears in note and claim, but no active authorization covers the service date.
SOAP note and claim are linked for audit support.
Why now
ABA billing scrutiny is moving from isolated audits to an operating risk.
Public audits are repeatedly landing on the same provider-level failure points: thin session notes, unsupported billable time, credentialing gaps, authorization breakdowns, concurrent billing, and services that do not match the record.
100/100
Sampled months with claim issues
In Colorado's completed ABA report, all 100 sampled enrollee-months included at least one improper or potentially improper claim line.
HHS OIG Colorado$81.2M
TRICARE documentation exposure
DoD auditors projected $81.2M in improper TRICARE ABA payments in one region, driven by missing or insufficient records supporting paid claims.
DoD OIG$8.8M
ABA False Claims settlement
Early Autism Project paid $8.8M to settle allegations that ABA services billed to TRICARE and South Carolina Medicaid were misrepresented or not provided.
U.S. DOJClaimo does not replace legal, billing, or compliance judgment. It gives operators a structured view of the records and billing patterns that tend to surface in payer reviews.
Join the listPut risky dollars in view
Put risky dollars in view
while they can still be fixed.
Join the pre-launch cohort for ABA teams that want claims, notes, and authorizations reviewed together before payer review becomes a fire drill.
HIPAA-safe · PHI stripped before AI · Built for ABA billing teams