Penguin Health
Penguin Health provides an automated, read-only audit platform that reviews 100% of ABA session notes against payer, state, and authorization requirements before claims are submitted. The system flags documentation issues, tracks supervision ratios and authorization utilization, and assigns findings to QA teams without changing clinician workflows. It includes a rules library covering 28 states plus TRICARE, with 244 payer-specific rules built from primary source documents.
- Regulatory & Compliance Technology
- Healthcare Technology
- Digital Health
- Software Only
Funding
Founders
Founder details are not available yet.
Product
Problem
ABA providers face high rates of claim denials and improper payments because session notes frequently fail to meet payer documentation requirements, state rules, or client authorization caps. Manual chart reviews catch only a sample of issues, and providers often discover problems only when the remittance comes back, resulting in lost revenue and audit risk.
Solution
Penguin Health acts as an automated, read-only auditor that reviews every session note and billing entry before claims are submitted. The platform checks each note against the supervising BCBA, the RBT who delivered the service, the applicable authorization, and payer-specific rules configured for the provider's states and note templates. When issues are found, the system tells the team exactly which notes need fixing and flags risks such as supervision ratio breaches or authorization overutilization. RBTs and BCBAs continue documenting exactly as they do today, with no clinician workflow change required, while clinical directors and QA leads receive prioritized lists of notes needing attention.
Target Audience
Primary customers are ABA provider organizations, including clinical directors, QA leads, and billing teams who need to ensure clean claims and maintain regulatory compliance for Medicaid and commercial payers.
Features
- Pre-billing audit engine that reviews 100% of session notes, not a sample, against payer, state, and authorization requirements
- Configurable rules library including state-specific rule sets such as the Colorado ABA documentation requirements derived from the HHS OIG audit A-09-24-02004
- Real-time tracking of supervision ratios and authorization utilization, showing units billed versus units authorized
- Read-only access inside the provider's existing system with a BAA executed first and no change to clinician workflows
- Flagging and prioritization of note-level fixes for QA teams, clinical directors, and billing staff, with documentation quality tracking per employee over time
- Rules library covering 28 states plus TRICARE, with 244 payer-specific rules built from 59 primary source documents, each cited and verified with a date
- Rule packs are watched for revisions, with re-verification when states update their manuals or policies