Built by operators who ran ABA Medicaid billing.

Medicaid claims that ship clean. State rules built in.

State rule packs. Built-in EVV where your state mandates it. Insurance capture and authorization tracking. ERA auto-posting and denial routing. Multi-payer and multi-state on one client record.

Medicaid rules per state

State rule packs

visit verification, not a bolt-on

Built-in EVV

scrubbing every Medicaid claim

Pre-submit

ERA posting + denial routing

Live

The short answer

How do you bill Medicaid for ABA therapy?

Billing Medicaid for ABA follows the same sequence in every state: get eligibility and prior authorization on file, deliver and document the session against an authorized code, capture EVV where the visit is in the home, then submit the claim with the state’s required modifiers inside its timely-filing window.

• Confirm the client’s Medicaid eligibility and obtain prior authorization before the first billable session.
• Deliver and document the session against an authorized CPT code in the 97151–97158 family.
• Capture electronic visit verification for in-home visits and send it to the state’s EVV aggregator.
• Apply the rendering-provider modifiers the state requires, which vary by state and by credential.
• Submit inside the state’s timely-filing window, then reconcile the ERA against what was authorized.

The CPT codes are national; the modifier sets, rate schedules and EVV aggregators are set by each state Medicaid program, so the rules around those codes are not.

What is ABA Medicaid billing software?

The Medicaid revenue cycle for ABA — state rules and EVV, built in.

ABA Medicaid billing software handles the revenue cycle for ABA claims submitted to Medicaid and Medicaid managed-care organizations: insurance capture at intake, authorization unit tracking, claim creation with ABA codes and state-specific modifier rules, claim scrubbing, Electronic Visit Verification where mandated, ERA posting, and denial routing.

Medicaid is uniquely demanding for ABA. Billing-code and modifier rules vary by state and managed-care organization. Some states mandate EVV for ABA and some do not. Authorizations have fixed cycles and unit caps. Generic medical billing adapted for ABA will always be working around these specifics. Wilma® encodes them — with state rule packs applied per claim and EVV captured natively where your state requires it, so verified visits flow straight into clean Medicaid claims.

Medicaid claims caught before they ship — not in a denial 45 days later.

With the AI add-on (+$20/user/mo, layered on Core), every Medicaid claim runs through state rule packs and payer-specific scrubbing before it leaves: modifier sets, authorization units, documentation completeness, and code combinations. Gaps surface live in the billing queue for your biller to fix.

State rule packs

Each state’s Medicaid billing-code and modifier rules applied per claim.

Per-payer logic

Medicaid, MCOs, and TPAs — each set of rules encoded natively.

Documentation gaps

Missing signatures, incomplete notes, absent language — flagged pre-claim.

Billing queue, not a spreadsheet

Gaps routed to the right biller with context. Fix in two minutes.

Electronic Visit Verification, native — where your state mandates it.

Wilma includes EVV. Time- and location-stamped visit verification is captured on the same schedule your team already uses and feeds billing directly. Some states mandate EVV for ABA and some do not — Wilma applies verification where your state requires it, with no separate portal to reconcile.

Built in, not bolted on

EVV lives on the same schedule and billing record as everything else.

Time + location stamped

Geofenced clock-in/out where your state mandates EVV.

Verified → billable

A verified visit feeds the claim on the same record — no re-keying.

Audit-ready lineage

Visit-to-claim trail for every Medicaid session.

Medicaid insurance captured at intake. Authorizations tracked before they lapse.

Insurance is captured at the front door at intake. Authorization units decrement per session against allowed Medicaid services, and renewal cycles surface weeks ahead with clinical documentation pre-assembled for the BCBA.

Intake-time insurance capture

Medicaid plan and member details captured on the record at intake.

Authorization unit tracking

Unit balance live, decremented per session, alerts ahead of renewal.

Clinical prep for renewals

Progress data, goal mastery, session history — assembled for your BCBA.

Authorization-aware schedule

Sessions checked against authorized units before they’re delivered.

Remittance posts itself. Denials route with context.

Electronic Remittance Advice posts to the right claim automatically, so reconciliation is a dashboard, not a job. Denials route to the right team categorized by root cause — modifier, authorization, or documentation — so the fix is obvious and fast.

ERA auto-posting

Medicaid payments applied to claims live, reconciled on one record.

Denial routing

Routed to the right biller with context, categorized by root cause.

Root-cause analytics

Modifier, authorization, and documentation denials tracked over time.

Days-in-AR visibility

Aging buckets and collection velocity by payer, live.

One client record. Multiple payers, multiple states, no workarounds.

NPI, tax ID, and billing address per location. State-specific Medicaid rule packs and EVV requirements applied per claim. Multi-payer support on a single record — Medicaid primary with commercial or secondary coverage handled on the same client.

Multi-payer on one record

Medicaid primary, commercial or secondary — coordinated on one client.

Per-location billing identity

NPI, TIN, address — correct on every claim.

State rule packs

State-specific Medicaid billing-code, modifier, and EVV rules per claim.

Rollup reporting

Cross-entity financial and operational rollups for ownership.

Buyer's Checklist

Evaluating ABA Medicaid billing software? Demand every line.

FAQ

Questions operators ask about ABA Medicaid billing.

What is ABA Medicaid billing software?

Does Wilma include EVV for Medicaid claims?

How does Wilma handle different state Medicaid rules?

Can Wilma bill Medicaid and commercial payers on the same client?

What is Medicaid claim scrubbing?

How much does Wilma cost?

Is Wilma HIPAA compliant?

Customer Story · Billing & RCM

How a practice recovered written-off revenue — and stopped paying a cut of every dollar

Why they brought billing in-house instead of surrendering a percentage of every collection.

See Medicaid billing that ships clean.

Thirty minutes. Bring your state, your payer mix, and a recent Medicaid denial — we’ll show you how it would have been caught.

CPT® is a registered trademark of the American Medical Association. CPT codes, descriptions, and other data are copyright © American Medical Association. All Rights Reserved. CPT is provided “as is” without warranty of any kind, either expressed or implied, including but not limited to the implied warranties of merchantability and fitness for a particular purpose. The AMA does not directly or indirectly practice medicine or dispense medical services.

Keep reading

Related guides on running an ABA practice — the same operation, from a different angle.

• Authorization tracking softwareUnits remaining, expiry warnings, and the alerts that stop unbillable sessions.
• ABA CPT code referenceThe 97151–97158 family explained, with the modifier rules payers actually enforce.
• ABA billing servicesWhen to run billing in-house and when to hand it over — and what each really costs.
• ABA billing softwareCPT 97151–97158, pre-submission claim scrubbing, and a denial workflow that closes the loop.
• Best ABA practice management softwareThe main platforms compared on scope, pricing model and who each one fits.
• ABA scheduling softwareAuthorization-aware scheduling that respects credentials, drive time and cancellations.