Claimo — ABA documentation & payer-risk review

Built for ethical ABA practices navigating tighter payer review

Pre-launchOnboarding select ABA practicesNote QA for session notesMedicaid + commercial payersNotes + plans + claims + authsPayer-facing risk posturePHI stripped before AIHIPAA-aligned safeguardsAudit trails built inSingle- and multi-sitePre-launchOnboarding select ABA practicesNote QA for session notesMedicaid + commercial payersNotes + plans + claims + authsPayer-facing risk posturePHI stripped before AIHIPAA-aligned safeguardsAudit trails built inSingle- and multi-site

Why Claimo

One review across the records payers actually scrutinize.

Medicaid and commercial reviewers are flagging thinner notes, tighter treatment plans, and stricter reauths. Claimo connects notes, plans, claims, and authorizations so your team can fix issues before they become denials, terminated payer contracts, or canceled reauths.

Start with the notes payers scrutinize.

Upload session notes with the claims, authorizations, treatment plans, and payer rules that give those notes context. PHI is stripped before AI review.

Match every billed line to its support.

Each service line is checked against its session note, treatment plan context, and authorization coverage, so missing documentation, CPT/unit mismatches, and auth gaps show up together.

See your practice the way risk reviewers do.

Claimo rolls 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 reviews across your practice.

Three operating views of one system: practice-level payer risk, authorization coverage, and line-level support across notes, treatment plans, and claims.

01Command Center

A payer-risk score for your practice, not just a note checklist.

The 0–100 Practice Risk Score rolls up documentation quality, billing patterns, cross-document consistency, recurrence, and utilization so operators can see how risky the practice looks across the records payers review.

Score updates as new claims, notes, and authorizations are processed
Top risk drivers name the finding, the records behind it, and how many points it adds
Critical items surface together: weak notes, expiring auths, credential mismatches, and pattern outliers
Factor-level breakdown across the five risk dimensions, with score 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.

LowModerateHighCritical

Billed $ at risk

$189,500

11% of billed dollars

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.

02Authorization Intelligence

Every unit billed, mapped to authorization coverage.

Claimo tracks authorization windows, CPT-level units, burn rate, and reauthorization readiness so expiring, exhausted, or uncovered services are visible before they turn into avoidable billed exposure. It also flags practice-wide billing patterns — the kind insurers and government auditors use to target entire centers.

Active authorizations grouped by client, payer, CPT, and urgency
Units used vs. authorized, with expiration countdowns and over-limit flags
Reauthorization readiness and queue status before the current auth runs out
Billing pattern outliers that can trigger payer audits or government scrutiny across the whole practice

Authorization intelligence

Coverage for every billed date

14 providers · 96 active clients · 11 payer plans.

Synced today

Active auths

Across Medicaid and commercial

Expiring soon

Due in the next 30 days

Over limit

$18.6K billed past coverage

Active authorization watchlist

Sorted by urgency

A-3142AetnaCPT 97153

Client 4281

Packet ready

312 / 400 units78%

Days remaining 9Reauth file queued

A-2987UnitedCPT 97156

Client 3107

Over limit

64 / 60 units107%

Expired 2Reauth file queued

03Note QA + claim reconciliation

Every billed line, reconciled to its note and authorization.

Claimo links each claim service line to its session note, treatment plan context, and the authorization that covers the date of service. The review view shows what is supported, what is mismatched, and which billed dollars need attention.

Session-note QA connected directly to 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

Claims 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

Needs review

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.

Why now

The risk of poor notes does not stay inside the note.

Payer scrutiny usually starts with a note or treatment plan, but exposure spreads across claims, auths, credentials, and utilization. Ethical practices are doing more paperwork for every reauth — Claimo helps you review those records before a denial or clawback arrives.

$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 OIG

100%

Four-state samples with claim issues

Across completed Colorado, Indiana, Maine, and Wisconsin audits, every sampled enrollee-month included at least one improper or potentially improper claim line.

HHS OIG audit series

$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. DOJ

Claimo does not replace legal, billing, clinical, or compliance judgment. It gives operators a structured review of notes, treatment plans, claims, and billing patterns that tend to surface in payer reviews.

Join the list

Start with note QA. Leave with a payer-risk picture.

Join the pre-launch cohort for ABA teams that want notes, treatment plans, claims, and authorizations reviewed together — before the next denial or reauth fire drill.

Join the waitlist

PHI-minimized · Notes, plans, claims, auths · Built for ABA billing and compliance teams

Catch revenue riskbefore it costs you.