Welcome to the Real-World ABA Billing Simulation: Wrong Medicaid Plan Billed

In this interactive activity, you will step into the role of a biller at a Florida-based autism center managing real insurance denials. Your task is to navigate a challenging situation where a client’s Medicaid plan switched from Sunshine Health to Simply Healthcare without notification, leading to denied claims.

You will be presented with a series of decision points. Each choice you make will influence the next steps and ultimately determine whether the claims are recovered, delayed, or result in a financial loss for the clinic.

The simulation is designed to mimic the pressures and complexities billers face in real-world ABA billing operations. There are no “dead ends” — even incorrect choices will move you forward, but they will create additional challenges you must overcome. Pay close attention to payer rules, Medicaid policies, and best practices as you make your decisions.

Get ready to test your problem-solving skills and learn how to think critically when managing insurance claims under pressure!

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