Auto-Generated Claims
Claims created automatically when session notes are completed. All billing codes, modifiers, and authorization references populated instantly.
The "Glass Box" Revenue Defense Engine
ABA Billing Software That Defends Every Dollar
Don't just outsource billing. Gain clarity. VGPM shows you every claim, tracks every denial in real-time, and automates payment posting so you can make payroll with confidence. See the full revenue picture, from session to deposit.
95%+
Clean Claim Rate
Pre-submission validation catches errors before they become denials
50%
Faster Posting
Automated ERA processing eliminates manual payment entry
Real-Time
Denial Tracking
See denials the moment they happen, not weeks later
Claims Management
How Does ABA Billing Software Handle Claims?
VGPM automates the entire claims lifecycle, from session completion to payment posting, with real-time visibility at every step. Each claim validates against the client's active authorization and the provider's credentials before anything leaves your system.
Session Complete
Note signed, ready to bill
Claim Generated
Auto-created with all data
Submitted
Sent to payer electronically
Accepted
Payer received, processing
Payment Posted
ERA processed, revenue recorded
Pre-Submission Validation
Authorization limits, provider credentials, and payer rules checked before submission. Catch problems before they become denials.
ERA Auto-Processing
Electronic remittance files parsed automatically. Payments posted, adjustments decoded with human-readable explanations and suggested next steps, patient responsibility calculated. No manual entry.
Bulk Operations
Submit, void, or resubmit multiple claims at once. Filter by date, payer, or status and act on hundreds of claims in seconds.
Claims List
2 Tags Active
97153$125
97155$85
97151$210
97153$125
Filter by Tag
Workflow Organization
Tag Claims Your Way, Find Them Instantly
System statuses tell you where a claim is. Tags tell you what to do next. Create custom labels for follow-ups, payer issues, priority work, or anything your workflow needs. Filter by tag to work through queues efficiently. For a deeper look at ABA billing codes and when to use each modifier, see our CPT code reference.
Multi-tagging supported Bulk tag operations Full audit history
Visual Organization
Color-coded tags with unique icons make problem claims instantly recognizable. No more hunting through spreadsheets.
Spot issues at a glanceSmart Filtering
Filter your claims list by any combination of tags. Work through your follow-up queue methodically every morning.
Work smarter, not harderWorkflow Queues
Create custom workflows: tag claims needing follow-up, filter daily, resolve, remove tag. Your denial management system.
Nothing falls through the cracksComplete Audit Trail
Every tag change is logged in the claim timeline. Know who tagged what and when for compliance and team accountability.
Full visibility for your teamYour Tags, Your Workflows
Create tags for anything: Follow Up Today, BCBS Auth Issue, High Dollar Priority. Tags are fully customizable, and every change is tracked in the claim's audit timeline.
Patient Invoicing
How Do I Bill Patients for Their Portion?
VGPM automatically generates patient invoices from insurance EOBs, tracks payments, and manages write-offs, recovering the 20-40% of revenue that comes from families.
1
ERA Processed
Insurance pays their portion, patient responsibility identified
2
Invoice Created
Patient invoice auto-generated with copay, coinsurance, or deductible
3
Reminders Sent
Automated emails notify families of balance due
4
Payment Received
Card, ACH, check, or online portal payment recorded and reconciled
Automatic Invoice Generation
Patient invoices created automatically from ERA data. No manual calculation of copays, coinsurance, or deductibles.
Multiple Payment Methods
Accept credit cards, ACH transfers, checks, and online portal payments via Stripe. Payment plans for larger balances. All tracked in one place.
Learn about Stripe IntegrationAutomated Reminders
Configurable reminder emails for unpaid invoices. Set timing, frequency, and tone. Stop chasing payments manually.
Write-Off Management
Track contractual adjustments, bad debt, and courtesy write-offs separately. Approval workflows prevent unauthorized write-offs.
Don't Leave Money on the Table
For many ABA practices, 20-40% of revenue comes directly from families: copays, coinsurance, and deductibles. VGPM ensures you capture every dollar with automated invoicing and persistent but professional follow-up. With VGPM's Stripe integration, families can pay invoices online through the client portal, making it easier to collect and faster to reconcile. Need help managing the insurance side? VG Soft's RCM service handles claim submission, denial follow-up, and payment posting for you.
Claims Visibility
Where Is Every Insurance Dollar Right Now?
Your Claims List is your revenue command center. See every claim's status, filter to what matters, and track totals in real-time. No waiting for reports, no hidden queues, just transparent visibility into your practice's cash flow.
Claims List
3 Filters
Status: Ready
Last 30 Days
All Payers
Filtered Totals
Billed$127,450
Ins. Paid$98,320
Patient Resp.$12,840
Pending$16,290
Martinez, Sofia$1,240.00Ready
Chen, William$2,180.00Pending
Johnson, Aiden$890.00Reconciled
Filter to What Matters, See the Totals Instantly
Your Claims List defaults to showing problem claims: rejections, errors, and items needing review. Filter by status, payer, provider, or date range, and the totals panel updates in real-time. No separate reports to run.
Instant totals by any filter Default problem-claim view Export to CSV anytime
Real-Time AR Monitoring
Your Claims List totals panel shows billed, paid, pending, and patient responsibility amounts, updating instantly as you filter. No waiting for nightly reports.
- Billed, Ins. Paid, Patient Resp. at a glance
- Totals update as filters change
- Filter by payer to see performance
- Spot revenue trends immediately
Smart Claim Workflow
The default view shows claims needing attention: rejections, errors, and items in review. Work your problem queue first, then batch-submit ready claims.
- Default: Problem claims only
- Filter by 12 claim statuses
- Filter by payer, provider, code
- Bulk "Send All" ready claims
Export for Analysis & Reconciliation
Export filtered claims as CSV summaries or line-item detail. Analyze CPT code revenue, payer performance, or reconcile with your accounting system.
- Claims CSV: Summary per claim
- Claim Items CSV: Line-item detail
- Export respects active filters
- Perfect for month-end close
Transparency, Not Black Boxes
Every claim status is visible. Every filter is yours to control. See exactly what's billed, what's pending, what's paid, and what needs attention. No hidden queues, no mystery reports, just a glass box view of your revenue cycle. Compare how VGPM's billing stacks up against other platforms in our ABA billing software comparison. Weighing whether to handle billing in-house or outsource? Read our in-house vs. outsourced billing guide.
Industry Context
Why ABA Billing Is Uniquely Complex
ABA billing is not standard medical billing with a different CPT code. The combination of authorization-dependent services, credential-specific modifiers, and multi-payer fragmentation creates failure modes that general billing tools are not built to catch.
Revenue Cycle Fragmentation
A single ABA practice can bill 10 or more payers, each with different fee schedules, submission portals, timely filing windows, and modifier requirements. One set of rules does not carry over to the next.
Authorization-Billing Coupling
Every billed session must trace back to an active authorization with remaining units. If the auth expired yesterday or the units ran out last week, the claim gets denied automatically. Manual tracking breaks down at scale.
Modifier Compliance
ABA claims require credential modifiers (HM for RBTs, HN for BCaBAs, HO for BCBAs), telehealth modifiers (GT, 95), and encounter modifiers (XE). The wrong combination means a denied claim, and the rules vary by payer.
Timely Filing Deadlines
Commercial payers typically allow 90 days to submit a claim. Medicaid can be up to 365 days. Miss the window and the revenue is gone permanently. No appeal, no exception, just a write-off.
Denial Cascade Effect
One systematic error (wrong modifier on a template, expired provider NPI, incorrect place of service code) can silently produce dozens of denied claims before anyone catches it. The longer it takes to spot the pattern, the bigger the revenue hole.
Deep Dive: ABA CPT Codes and Modifiers
For the full breakdown of all 10 ABA CPT codes, modifier combinations, the 8-minute rule, and the 2027 code overhaul, see our ABA Billing Codes 2026 reference guide.
Real-World Scenarios
How Automated Billing Protects Revenue
These are not hypotheticals. They are the billing errors that cost ABA practices thousands of dollars every month, caught before they become write-offs.
Prevented: 47 denied claims in a single billing cycle
The Modifier Mismatch Catch
1
Claim Created
Billing staff generates claims for a week of sessions. One provider's claims auto-populate with 97153-HN (BCaBA modifier).
2
Validation Flags
VGPM checks the rendering provider's credentials. This provider is an RBT, not a BCaBA. The correct modifier is HM.
3
Error Surfaced
A clear warning appears on all 47 claims before submission: "Modifier mismatch: provider credentialed as RBT (HM), claims generated with HN."
4
Batch Corrected
Billing staff corrects the modifier across all 47 claims in one operation and submits the batch clean.
47 claims submitted correctly on the first attempt. Without pre-submission validation, those denials would have taken 3 to 6 weeks to surface and another billing cycle to rebill.
Prevented: $12,000 in permanent write-offs
The Timely Filing Save
1
Sessions Aging
A clinical director has 60-day-old sessions with unsigned notes blocking claim creation. The payer's filing deadline is 90 days.
2
Aging Alert Fires
VGPM surfaces the unbilled sessions in the aging queue, showing days remaining before the timely filing window closes.
3
Notes Completed
The clinical director prioritizes signing the overdue notes. Claims generate automatically once notes are finalized.
4
Claims Submitted
All claims go out 3 weeks before the filing deadline. Payment posts within the normal cycle.
$12,000 in revenue that would have become permanent write-offs, recovered because the system surfaced the problem with enough time to act.
The Transformation
The Billing Nightmare, Over
Without VGPM
With VGPM
Manual claim scrubbing in spreadsheets before every submission
Automated clean claim validation catches errors before they leave your system
Denials discovered 3 to 6 weeks after submission, buried in ERA files
Real-time denial alerts with plain-language explanations and recommended next steps
Revenue tracked across disconnected spreadsheets, reports run weekly
Glass Box dashboard showing every dollar from session to deposit, updated in real-time
Timely filing deadlines tracked on calendar reminders, missed when staff is out
Aging claim alerts flag at-risk revenue automatically, regardless of who is in the office
Write-offs categorized as "other" with no root cause analysis
Denial analytics by reason code, payer, and provider, so you can fix the pattern, not just the claim
Want to hand off billing entirely? VG Soft Co's Revenue Cycle Management service takes the claim data flowing out of VGPM and handles submission, denial follow-up, payment posting, and reporting. Your team focuses on scheduling and clinical work. We handle the revenue cycle.
What ABA Practices Are Saying
Using the AI session notes features is saving me hours a week when it comes to documentation. And it does a great job.
Our therapist used to be weeks behind on documentation. VGPM makes it so easy, they are now finishing by the end of the session.
The automated billing make billing easy enough that I don't need to hire someone to do it full time.
I've never had a software company actually build something I asked for before.
It's so nice that VGPM has everything built in, unlike our last software that just had a bunch of integrations.
The scheduling locks saved us from a nightmare. We had an RBT working under an expired authorization for two weeks before we caught it at our old software. That can't happen in VGPM.
I can finally see where every dollar is in the revenue cycle without pulling reports from three different systems. The claims page alone was worth switching.
Data collection is actually usable with one hand during a session. I used to dread graphing at the end of the day. Now it's already done by the time I walk out.
We switched from CentralReach and we migrated everything in under three weeks. There were a few hiccups with payer setups, but they resolved them fast.
Denials used to pile up and I had no idea which ones to chase first. VGPM makes it easy to prioritize and manage them. I'm actually caught up for once.
The flat $50 per staff pricing is what got me to look, but the authorization tracking is what sold me. We stopped losing money on sessions that shouldn't have been scheduled.
Parents love the client portal. They can see upcoming sessions, review session notes, and pay their invoices without calling us. It cut our front desk phone volume in half.
Frequently Asked Questions
When a session note is completed, VGPM automatically generates a claim item with all required data: billing codes, modifiers, units, dates, provider credentials, and authorization reference. Claims batch automatically based on your submission schedule and are sent electronically to payers. You see every claim's status in real-time, from pending to submitted to paid.
Denials are caught instantly when the ERA (Electronic Remittance Advice) is processed. VGPM categorizes each denial by reason code (CO-4, CO-16, CO-18, etc.) and shows you exactly what went wrong. Every adjustment code includes a plain-language explanation of what it means and a recommended next step, so your team knows immediately whether to appeal, rebill, or write off.
Yes. When an ERA shows a patient responsibility amount (copay, coinsurance, deductible), VGPM automatically generates a patient invoice. Families can pay via credit card, ACH, check, or online through the client portal using VGPM's Stripe integration. You can set up payment plans for larger balances. Automated reminder emails go out for unpaid invoices, and you control the timing and frequency.
The Claims List shows all claims with their current status, aging buckets (0-30, 31-60, 61-90, 90+ days), and expected payment amounts. Filter by payer, status, date range, or provider to find exactly what you need. The totals panel gives you real-time summaries of billed, pending, and collected amounts.
VGPM supports unlimited insurance payers with payer-specific billing rules. Each payer can have different submission formats, timely filing limits, and authorization requirements. The system tracks which clients have which payers and applies the correct rules automatically.
Multiple validation layers catch errors before they become denials. Authorization validation ensures you never bill beyond approved units. Credential checking confirms the rendering provider is credentialed with the payer. Date-of-service validation catches late submissions before timely filing limits expire. If something's wrong, you see a clear warning, not a denial 30 days later.
A clean claim is one that's accepted by the payer without needing corrections or resubmission. Industry average is around 80%. VGPM practices typically achieve 95%+ because the system validates claims before submission. Higher clean claim rates mean faster payment, less rework, and better cash flow.
VGPM tracks three types of write-offs: contractual adjustments (automatic from ERA), bad debt write-offs (uncollectable patient balances), and courtesy write-offs (hardship cases). Each requires appropriate approval and creates an audit trail. Write-off reports help you monitor trends and protect against revenue leakage.
Ready to Protect Your Revenue?
See how VGPM's billing automation can defend every dollar your practice earns. Watch our demo to see the "Glass Box" Revenue Defense Engine in action.