PATTERNS ABA COMPANY LLC provides insurance-authorized Applied Behavior Analysis (ABA) services based on medical necessity and in accordance with payer guidelines, state regulations, and professional standards of care.
All services are evidence-based and designed to address functional deficits associated with Autism Spectrum Disorder and related developmental conditions.
Medical Necessity & Authorization
ABA services are initiated following a comprehensive behavioral assessment conducted by a Board Certified Behavior Analyst (BCBA). This assessment establishes medical necessity and determines the type, frequency, and duration of services requested for authorization.
Services are provided only after:
- Insurance eligibility is verified
- Required authorizations are obtained
- Treatment plans are approved by the payer
Authorization is required prior to the delivery of services and does not guarantee payment.
Individualized Treatment Planning
Each client receives an individualized ABA treatment plan that includes:
- Clinically justified, measurable goals
- Data-driven intervention strategies
- Ongoing progress monitoring
- Periodic plan reviews and updates
Treatment plans are reviewed regularly and modified based on progress, clinical judgment, and payer requirements. Services may be adjusted, reduced, or discontinued when goals are met or when medical necessity criteria are no longer satisfied.
BCBA Supervision & Service Delivery
- All ABA services are developed, supervised, and reviewed by a BCBA.
- Direct therapy is provided by trained behavior technicians under BCBA supervision.
- Supervision frequency meets or exceeds insurance and Medicaid standards.
Documentation & Compliance
PATTERNS ABA COMPANY LLC maintains clinical documentation required by insurance providers, including:
- Initial and ongoing assessments
- Treatment plans aligned with authorization criteria
- Session notes and data collection
- Progress reports and reauthorization summaries
All documentation is completed accurately and maintained in compliance with payer, state, and federal requirements.
Insurance & Medicaid Compliance
Services are provided in accordance with:
- Commercial insurance policies
- Oklahoma Medicaid and Medicaid Managed Care Organization (MCO) guidelines
- HIPAA privacy regulations
- BACB Ethical Code for Behavior Analysts
Claims are submitted only for services that are authorized, rendered, and documented.
Insurance Coordination Notice
PATTERNS ABA COMPANY LLC assists families with benefit verification and authorization coordination; however, coverage and reimbursement are determined by the insurance provider. Families are responsible for understanding their plan benefits, including deductibles, copays, coinsurance, and non-covered services.
PATTERNS ABA COMPANY LLC 