ABA Prior-Auth and Denial Cost Calculator
Enter your clinic's numbers to see what prior-auth denials are costing you each month, and how much a Relay AI employee could recover by handling authorization work before claims go out.
Revenue lost to denials per month
$3,840
Recoverable revenue per month
$1,440
The share above the HFMA under-5% benchmark. Shows $0 if you are already at or below 5%.
Staff hours freed per month
36 hours
Relay's working assumption that automation removes roughly 60% of authorization time.
Revenue lost per year if nothing changes
$46,080
ABA is billed in 15-minute timed units under CPT 97153 (direct therapy) and 97155 (protocol modification). Four units equal one hour. Source: AMA CPT code set.
All figures come from the numbers you entered. No sourced reimbursement rate or payer benchmark is embedded in this calculator. The only external benchmark used is HFMA's standard: a denial rate under 5% is considered optimal; 5-10% is industry average. Recoverable revenue represents the gap above the 5% floor and is $0 if your denial rate is already at or below 5%.
Common questions.
What counts as an authorized therapy hour for ABA?
Any hour of direct or supervised ABA service covered by an active prior authorization. Multiply your authorized units by 0.25 to convert to hours (four 15-minute units per hour).
Why does recoverable revenue only count the gap above 5%?
HFMA treats a sub-5% denial rate as optimal. Some baseline denial volume is operationally unavoidable, so this calculator only flags the portion above that floor as recoverable through better auth management.
What does the AI employee actually do with authorizations?
Relay builds a custom AI employee that tracks authorization expiry, prepares renewal requests against your payer's requirements, and flags gaps before a claim goes out. A staff member reviews and submits. The AI does the bulk of the work; a human finalizes.
Are the default values real rates I should rely on?
No. The defaults are round, editable placeholders to get you started. Enter your clinic's actual hours, contracted rates, and denial rate for figures that reflect your practice.
See where this is leaking in your clinic
The calculator shows the gap. The free 30-minute intro call shows you which workflow an AI employee would close first.