Clinical
Supervision & Oversight
Supervision & Oversight is Coralia's module for tracking Behavior Analyst Certification Board (BACB) supervision compliance in an ABA agency: it grades every Registered Behavior Technician (RBT) and assistant analyst monthly against the 5% supervision-to-service floor and two-contact minimum, runs the supervisor's pending session-note review queue, and records dual-signed, tamper-evident supervision logs on the client's record.
The problem in real agencies
The Behavior Analyst Certification Board (BACB) requires every Registered Behavior Technician (RBT) to be supervised for at least 5% of the hours they spend delivering behavior-analytic services each month, across a minimum of two contacts. Most agencies track this in a spreadsheet someone reconciles after the month closes — so a shortfall surfaces only when it is already a certification and payer problem, not while there is still a week left in the month to fix it.
The documentation trails the work. A Board Certified Behavior Analyst (BCBA) overlaps an RBT's Tuesday session, models a procedure, gives feedback — and the log lands in a binder, a shared drive, or a system the billing team never opens. Signatures get collected weeks later. Meanwhile submitted session notes stack up waiting for supervisor review, and nobody can say which ones have been sitting more than two days without opening each note individually.
Then the audit letter arrives. Medicaid programs — in Florida, the Agency for Health Care Administration (AHCA) — ask who supervises whom and for the signed logs that prove it. Reconstructing a supervision hierarchy from memory and old schedules takes days, and any client without an assigned technician, or any supervisor whose license had lapsed on a contact date, becomes a finding. The record needs to already exist, signed and dated, before anyone asks.
How it works in Coralia
- 1
Log the contact on the client's record
A BCBA or Board Certified Assistant Behavior Analyst (BCaBA) opens the client's Supervision tab and starts a new log. The supervisee picker lists only RBT- and BCaBA-eligible staff. The log records date, time, and location; narrative feedback in two structured questions; scored performance indicators on a four-value legend; a goals-reviewed checklist tied to short-term and long-term objectives (STOs/LTOs); and Current Procedural Terminology (CPT) code, units, and a billable flag — the code defaults to 97155, protocol modification. On save, the clinical content is encrypted and the write is audited.
- 2
Dual-sign it — then it locks
Supervisor and supervisee each sign from the log view. Identity is enforced on the server: only the recorded supervisor can sign as supervisor, and only the recorded supervisee can acknowledge. Signatures are typed or drawn; drawn signatures are validated PNG images streamed back only through an access-checked proxy — the underlying storage URL never reaches the browser. Every signature carries a content hash of the comments, feedback, CPT code, units, and date — and once either party signs, the log can no longer be edited. A signer can date the signature to any day between the contact date and today.
- 3
Work the pending-review queue
The Supervision dashboard's Pending Review tab defaults to 'Mine to sign' — session notes from clients where the reviewer holds an active supervisory case assignment, never the reviewer's own sessions — with an 'All agency' view one click away. Stat pills show pending, overdue (more than 48 hours since submission), and reviewed-today counts. The reviewer approves notes singly or in batch — every approval captures a signature attestation — or sends a note back with a revision request and supervisor notes. Self-review is rejected on the server, except the 97151 behavior assessment a BCBA authors and self-signs.
- 4
Watch the ratio while the month is still open
The Ratios tab grades every RBT and BCaBA for the month: direct-service hours against supervisor-signed supervision hours, contact count, and a verdict — compliant at a 5% ratio or better with at least two contacts, warning between 3% and 5%, non-compliant below 3% or with fewer than two contacts. The list sorts worst-first under agency-wide summary chips, so the biggest gap is the first row. The math is strict: the numerator counts only signed logs, and the denominator counts only approved sessions delivered by RBTs and BCaBAs.
- 5
Give every technician their own number
Each RBT and BCaBA sees a self-scoped 'My Supervision' card on their own dashboard: their monthly ratio against the 5% BACB target, supervised hours next to direct hours, and a plain-language status note. The card shows nothing to staff who are not supervisees and never exposes another technician's numbers. Early in the month, before any session note has been approved, the ratios view shows neutral dashes instead of an alarming red zero and explains that ratios only count sessions after supervisor sign-off — the number lags the calendar by design.
- 6
Prove the hierarchy when the auditor asks
The Audit Center rebuilds the Lead Analyst → BCBA → BCaBA → RBT → client hierarchy live from active case assignments — there is no stored tree to drift out of date — flags clients with no technician assigned as coverage gaps, and exports the chart for Medicaid and AHCA audit requests. Supervision runs on the same assignments: the pending-review queue's 'Mine to sign' scope comes from the reviewer's active supervisory case assignments, so the hierarchy the auditor sees is the one reviewers work every day.
The specifics
A month is compliant only with a supervision ratio of 5% or higher and at least two contacts; 3–5% grades as warning, below 3% as non-compliant.
Session notes pending supervisor review for more than 48 hours after submission are counted and filterable as overdue, with a dedicated stat pill.
Every signature stores a content hash of comments, feedback, CPT code, units, and date, plus signer credential, signature method, IP address, and browser.
Only staff holding a BCBA or BCaBA role can author a supervision log or sign as supervisor — resolved server-side from the authenticated user.
The ratio numerator counts only supervisor-signed logs; the denominator counts only approved sessions delivered by RBTs and BCaBAs — BCBAs themselves are not measured.
Scored performance indicators use a four-value legend, with up to 100 indicators and 100 goals-reviewed checklist rows per log.
The pending queue's 'Mine to sign' scope covers clients where the reviewer holds an active supervisory case assignment and never includes the reviewer's own sessions.
Drawn signatures are validated PNG images streamed only through an access-checked proxy — the raw file URL is never exposed to the browser.
The audit hierarchy recognizes five case roles — Lead Analyst, BCBA, BCaBA, RBT, and Behavior Technician, with BT ranked at the RBT tier — derived live from case assignments.
Four critical credential families — license, Medicaid enrollment, CPR, and background screening — recognized across fifteen document-type spellings, are checked for supervisor credential lapse as of the contact date.
Integrations
Session Notes & Documentation — the pending-review queue draws from submitted session notes awaiting supervisor sign-off, with batch approval and revision-request actions · Audit Center — the supervision hierarchy org chart exports for Medicaid and AHCA audit requests · Billing & Revenue Cycle — billable supervision encounters are claimed as their own CPT 97155 sessions, and authorization-unit pickers only offer units matching the exact procedure code · Practice-management sync — supervision logs mirrored from an agency's previous system render read-only alongside native logs, with a banner warning reviewers when mirrored notes appear in the queue
Access control
Role-based permissions gate viewing supervision data separately from authoring logs and approving pending notes, and every per-client supervision route also enforces object-level client access. Beyond permissions, only staff holding a BCBA or BCaBA role can author a log or sign as supervisor — the role is resolved server-side from the authenticated user, never trusted from the browser.
Frequently asked questions
How does Coralia calculate the RBT supervision ratio?
Per calendar month: supervised hours from supervisor-signed supervision logs, divided by direct-service hours from approved sessions delivered by RBTs and BCaBAs. A month is compliant only with a ratio of 5% or higher and at least two supervision contacts — the two-contact floor is a fixed board standard, not an agency setting. Fewer than two contacts is non-compliant regardless of ratio.
Can an RBT see their own supervision compliance?
Yes. Every RBT and BCaBA gets a self-scoped 'My Supervision' dashboard card with their own monthly ratio against the 5% BACB target, supervised hours next to direct hours, and a plain-language status note. The card renders nothing for staff who are not supervisees and never shows anyone else's numbers — agency-wide ratios stay on the supervisor-facing dashboard.
Is supervision billed from the supervision log?
No. The log's CPT code, units, and billable flag are metadata for the record. A billable supervision encounter is claimed as its own CPT 97155 session, and automatic claim generation never reads the log. Approving a session note never generates a claim either — claim generation is a separate, deliberate step. 97155 itself is renderable by a BCBA, or by a BCaBA with the HN modifier, the billing modifier that marks a bachelor's-level provider.
What happens if a supervisor's credential had lapsed on the contact date?
When a log is authored, Coralia checks whether any of the supervisor's critical credentials — license, Medicaid enrollment, CPR, and background screening — was expired as of the contact date. If so, the log is flagged so leadership can see and remediate it. Recording is never blocked: the contact happened, and the record must exist. Flagging over blocking is a deliberate design choice.
How does Coralia help in a Medicaid or AHCA supervision audit?
The Audit Center rebuilds the Lead Analyst → BCBA → BCaBA → RBT → client hierarchy live from active case assignments and flags clients with no technician assigned as coverage gaps. Behind it sits a full trail: every supervision log create, edit, and signature is audited, and even listing the pending-review queue or the ratios view writes a protected-health-information access entry naming the surface and record count.