So you’ve started your ABA practice, and are finetuning the important details like billing and credentialing. Well, here’s what you need to know. Many practices handle billing differently based on practice size (the number of providers) and resource availability. In smaller practices, the primary clinician or solo practitioner often takes care of billing themselves. Some ABA practitioners have family members or part-time employees to handle billing complexities, while others outsource their billing to a specialized team.

Regardless, ABA insurance billing can be complex, often requiring knowledge and experience to do so effectively. So, it’s important to take the time to consider which option is best for you based on your skill set and bandwidth. However, whichever approach your practice decides to take, there are some additional key factors to consider:

Insurance 

One of the first questions you should ask is whether or not you will accept insurance. Most ABA practices rely on private insurance and government reimbursements. Some providers choose not to accept insurance because they don’t want to spend time joining provider panels, going through the credentialing process, and keeping up with the changing policies of each company. However, this is not common.

Many clients (and their caregivers) are looking for an ABA provider who can accept their insurance and will also bill secondary providers. 

This leads many ABA providers to get credentialed with as many insurance payers in their areas as possible, but this isn’t always necessary. Usually, there are a few major insurance providers in your area. It’s important to research which payers are commonly used in your region and complete the credentialing process for those payers. This reduces the number of relationships, payer requirements, and other details that you need to keep track of while optimizing coverage for clients in your area. 

Insurance Credentialing

We touched on credentialing a little in the previous section, but what is it? Insurance credentialing is the process a provider goes through to develop a relationship with an insurance payer, allowing the payer to reimburse the provider for submitted services. During this process, payers confirm that providers are qualified and legitimate to receive reimbursement for rendered services. Once you’ve decided whether your practice will accept insurance, credentialing is the next step, preparing you to be able to submit insurance claims.

Getting credentialed can feel like a mystery for new practice owners, constantly leaving you wondering if you’re doing it right. Here’s some things to know as you go through this process:

• It takes a while. The process takes anywhere from 60-120 days, if everything goes smoothly. That’s why, when opening a practice, we recommend one of the first administrative concerns you address is how you will handle billing and credentialing.
• Missing or incorrect information and/or documentation can delay the expected time frame.
• You will need to complete the credentialing process with each payer you wish to bill to. The process might be different for each payer, so it’s important to pay attention to each payer’s unique communications.
• If you will have multiple practicing clinicians at your practice, they will need to complete their own credentialing application. This is because insurance companies want to review everyone’s backgrounds and qualifications before providing reimbursements.

Insurance Credentialing vs. Contracting

In addition to the points above, it’s also helpful to know the difference between credentialing and contracting, two terms you’ll often hear and encounter.

• Credentialing: As mentioned, this is the process of verifying your qualifications to provide ABA services. It involves submitting documentation to insurance companies to demonstrate your licensure, certifications, and experience. Once credentialed, you become eligible to submit claims to that specific insurance company.
• Contracting: After successful credentialing, you can negotiate an in-network contract with the insurance company. This contract outlines the reimbursement rates you’ll receive for covered services.

In the next sections, we’ll cover both of these in more detail.

How Do I Get Credentialing with Insurance Companies?

Now that you have a full understanding of the what and why behind credentialing, let’s get into the actual aba insurance credentialing process. While credentialing timelines can vary, here’s a roadmap to get you started:

1. Secure Your Core Credentials:

While there are other credentials that might be required of you, you’ll want to at least have these ready for later in the process.

• National Provider Identifier (NPI): Obtain your free NPI through the National Plan and Provider Enumeration System. You’ve likely already done this step, but NPIs are required for all eligible healthcare providers, so make sure you do if you haven’t.
• Tax ID Number (TIN): This often gets confused with NPI, but these are two distinct identifications that eligible providers are required to have. If you haven’t already, you can learn more about obtaining your TIN here.
• State Licensure (if applicable): Check your state’s requirements for ABA providers. Depending on your role (BCBA or BCaBA), you might need a specific state license.
• BCBA or BCaBA Certification: Again, you likely already have this. But you’ll need to have your credentials ready for the credentialing process.

2. Prepare Your Credentialing Application:

Each insurance company has its own credentialing application and may require additional documents. Visit their provider section on their website or contact them directly for details. This will help prevent any mistakes or missing documentation that could delay your application.

Then, gather the required documents based on the specific insurance company’s instructions. This typically includes:

• Completed application form
• Copy of your NPI number
• Proof of BCBA/BCaBA certification or RBT license
• Cover letter or resume
• Professional liability insurance information
• Tax ID number
• Reference letters (may vary by insurer)
• Information about your practice

3. Submit Your Application and Follow Up

Audit your application for completion and accuracy, then submit it electronically through the payer’s portal. While you’ll have to repeat this step for each payer, it should be a lot easier considering you already have all the necessary information.

Remember, be patient. As mentioned, processing times vary but are often several months. After a reasonable amount of time (about 1-2 months), feel free to follow up on your application status to ensure everything is running smoothly. You can do this periodically until approval.

Moving from Credentialed to Contracted: The Contracting Process

Yay, you’ve finished the credentialing process and have been approved by the payer. However, you’re not quite ready to receive payment for services. Once credentialed, you’ll need to proceed with the contracting process.

Insurance contracting is where you finalize the stipulations around your financial agreement with payers. You’ll discuss key factors like reimbursement rates, how you’ll submit claims, and any quality-of-care standards you need to meet. The specifics of the contract will vary, but some common elements include payment rates, billing procedures, and utilization review processes. The goal is to negotiate a win-win agreement that keeps your practice financially healthy.

While a short process, here’s how that usually looks.

1. Contract Negotiation: The insurance company will send you an in-network contract outlining the reimbursement rates for covered services and any other terms of participation (e.g., utilization review procedures).
2. Review and Negotiation: Carefully review the contract. You may have some room to negotiate reimbursement rates, depending on the insurance company and your experience level. If needed, consult with other providers to assess fair rates.
3. Signing the Contract: Once you’ve reached an agreement on the terms, sign and return the contract to the insurance company. Congrats, the grueling process is now over, mostly…
4. Re-contracting: Most insurance companies require re-contracting every 1-3 years to maintain your in-network status. This typically involves updating your information and ensuring you meet their ongoing requirements.

Insurance Credentialing for Therapists: Tips & Considerations

• Prioritize Major Payers: Research the main insurance providers in your area and focus on getting credentialed with them first to maximize coverage for potential clients.
• Stay Organized: Maintain a system for tracking the status of each application and any communication with the insurance companies. This means keeping folders, logs, and notes for where you are in the process with each payer and what you still need to complete on your end.
• Marketing/Referral Opportunities: Often, caregivers start their search by contacting their insurance to see who is in-network. Other clinical and medical professionals do the same. Joining a payer’s provider panel is a great way to get your name out into the community and meet clients in their search for an ABA provider. 

How Will Your Practice Handle Billing?

Assuming you’ll be accepting insurance, you just went through a tireless credentialing process. You want to make sure it wasn’t all for nothing, and you get the best reimbursements from the payers you’re now contracted with. You want to ensure your billing is handled by someone knowledgeable about the ever-changing billing codes, payer requirements, legal requirements, etc. involved in ABA billing. If not, you risk payment delays, lost revenue, or worse, legal repercussions.

There are several ways you can handle billing to avoid the aforementioned consequences. Many ABA practices choose to use:

Revenue Cycle Management Services 

Revenue Cycle Management (RCM) services, also known as managed billing services, can be an incredible resource if you are not an expert on insurance billing and don’t have an in-house billing team. Hiring an RCM partner can be the thing that sets your ABA practice up for financial success. 

The right partner will offer services and tools like: 

• A Team of Trusted Billers: You have access to world-class billing team members with extensive ABA experience.  
• Streamlined Claim Submission:  The team handles both electronic and paper claim submissions depending on your funding source, as well as secondary insurance or payers.   
• Hassle-free Claim Follow-up: Your RCM team follows up on claims so you do not have to. They will work with insurance companies and funding sources on all unpaid and denied claims to ensure you receive proper payment for your services.  
• Comprehensive Reporting: You receive account ledgers and claims denial reports that create an action trail, documenting all follow-up correspondence with insurance companies and funding sources.  
• Client Benefit Verification: Verify your client’s coverage before a single service is rendered so everyone is aware of their billing responsibilities upfront.  
• Authorization Management: The team ensures you get paid on time by completing the appropriate criteria sheets and authorization forms. They will also contact insurance companies on your behalf to obtain approval for authorization requests.  

If RCM services sound like a solution for your practice, try WebABA’s team of managed billing experts.

Billing Software

Another potential solution is automated billing software, one of the primary features of practice management systems (PMS). This can be used on its own (many clinicians find billing much more manageable once it can be automated with technology) or used in tandem with revenue cycle management services (granting you access to easy control with a helping hand). However, many smaller practices find that billing software, even by itself, significantly improves their ability to handle billing. If you’re a smaller practice, you likely won’t have as many monthly claims, and might find that RCM services aren’t necessary for your current capacity.

ABA billing software can help create claims, documentation, invoices, electronic reports, and more. Many providers find this to be the best way to manage their billing since it integrates directly with their scheduling, allowing them to pull necessary information without jumping between software.

In addition to a managed billing team, WebABA offers industry-leading ABA practice management software, equipped with billing automation, scheduling, telehealth, data collection, and more.

If you’re interested in learning more about WebABA’s automated billing software, schedule a demo to see how it works.  

Takeaways

ABA insurance credentialing and billing can seem like endlessly daunting tasks. However, it’s a small step on your path toward a successful ABA practice. And with the right information and resources, it’s far less impossible than you’d think. Keep this blog handy as a guide to reference throughout your credentialing and contracting processes. And implement software and/or a team that makes billing the last thing you have to worry about.

Schedule a demo with WebABA so our experts can talk through your needs, and get you on the right track towards a thriving practice.