How to Set Up Your ABA QA Process for Tricare

By Zach Rosen (CEO, Brellium) and Dan Matas (CEO, OutcomesBase)

Introduction

Brellium helps dozens of ABA clinics across the country automate their note auditing with AI. OutcomesBase helps dozens of ABA clinics build robust Quality Assurance programs. We regularly get questions on how to QA Tricare notes, because Tricare has robust standards for ABA documentation.

Why is QA Not the Same Across the Board?

In theory, QA should be standardized across clinics by payer. In practice, this couldn't be farther from the truth. Payer rules and industry best-practice processes are opaque and not widely known, so every agency's QA requirements end up looking completely different.

Why QA is Important

1. To make sure your kiddos are being treated correctly and according to your clinical standards.
2. To make sure that every dollar your payers pay you stays in your pocket.

Tricare is notorious for regular QA audits on session documentation, and is meticulous when it comes to reviewing session notes for ALL of the criteria written in the Tricare Operations Manual (TOM).

Step 1: Setting Up Your Note Template

Good note template = way less time spent on auditing. It's essential to strike a balance between preset automated options and free text sections.

Recommendations for automation:

• Session info should be populated by your EMR
• Make sure your note template has a "plan" for how it should be filled out
• Sections like ABA techniques and interventions can be encoded into a checkbox section
• Use automated e-signatures if possible

Recommendations for free text:

• Clinical status: Discussing examples of what an objective status looks like is important for RBT training
• Session narrative: Your RBTs need to be able to talk about what happened in the session
• Additional Notes: Edge cases happen — providers need to explain exacerbating circumstances

Step 2: Outlining Clear Rules for Your RBTs and BCBAs

Your QA process is 50% setting up a great session note template and 50% training your staff well. Have a go-to person within your organization that providers can ask questions to. Establish a scoring rubric that can be used as an internal QA check. Outline exactly what should be noted in each free text section.

Step 3: Setting Up Your Audit Requirements

Make sure your audit criteria are actual Tricare requirements (see Tricare's Manual). Differentiate between clear cut technical audit requirements vs. clinical requirements. Consider setting up various templates for different payers. Adjust your criteria based on payer feedback and published changes.

Step 4: Setting Up Your Auditing Team (and Using Brellium!)

We usually see the most successful audit teams include BCBAs who've transitioned to the operations side. Your QA team lead should have a comprehensive understanding of both the clinical and business side of your clinic.

Brellium handles the manual auditing so your team can focus on helping providers improve their documentation and standard of care.

Manual audit tips:

• Mark "X" in each cell for each note that's passed audit
• Mark "Contacting Provider" in each cell for each note that failed audit
• Add conditional formatting to highlight cells that contain "Contacting Provider"
• Create a third tab with VLOOKUP/INDEXMATCH for error instances per provider

Step 5: How to Have RBTs and BCBAs Fix Errors

At the end of each auditor's day, they should send an individual email to the provider specifying the note's day and time, and what needs to be fixed. Mark "Notification Sent" cells as orange. Once fixed, mark the cell green.

Step 6: Responding to Tricare Audits

If you're manually auditing notes, ask your team to focus on only the clients the payer has requested for 1–2 weeks. It's essential the initial audit goes smoothly — if errors are found, Tricare may ask for a larger sample, and may claw back funds.

Brellium provides a clawback guarantee and lets you easily export all notes for the audit period in 3 clicks.