What is credentialing and why is it required in the ABA world?

A vital aspect of running a successful medical practice is meeting the credentialing requirements of your specific field in order to provide services to your patient population. Depending on your patient’s insurance policy, failing to meet the credentialing requirements may mean not receiving payment for your out-of-network claims.

Furthermore, if you are not credentialed with governmental insurance agencies such as Medicare, you cannot treat or collect payments from patients covered by the federal insurance program.

WebABA Professional can you help get started on the path to ABA credentialing, which means more exposure to potential patients. By helping behavioral therapy clinics that specialize in providing ABA outpatient therapy for children and adults meet the necessary requirements, we can help you grow your business and meet your financial goals.

Not familiar with what the credentialing process requires and consist of? Read on for more information.

The Basics

Credentialing is the process of getting onto an insurance panel, or becoming an in-network provider, which allows you to legally accept new patients and obtain payment for services rendered. Credentialing can be a relatively lengthy process and includes plenty of paperwork, so it is beneficial to the provider to have guidance from an agency like WebABA Professional.

Why Get Credentialed?

The vast majority of states are undergoing insurance reform, and with The Affordable Healthcare Act resulting in 20 million more Americans able to obtain the medical assistance they need, a wealth of new funding sources are providing financial stability for ABA agencies. Plus, with more than 3.5 million Americans living with autism spectrum disorder, the need for professional medical support means opportunity for those seeking to provide ABA therapy.

One of the most important benefits of being in-network with an insurance agency is the consistency in which you are able to work. Billing codes, rates, and expectations dealing with reports and deliverables are all consistent, which means you can more readily make important decisions because of the uniformity of the system you are working within.

Because many insurance companies now have dedicated autism teams to help in-network providers, you’ll also have the ability to make meaningful relationships with contacts within the organization that can quickly answer questions or help you with claim issues. This ultimately leads to better customer support as you can more efficiently obtain pre-authorizations, re-authorizations, or claims information online.

Another great benefit of becoming credentialed as an in-network provider is the ability to bill an insurance company electronically. Electronic claims are fast, traceable, efficient, and allow you to receive payment much more quickly than traditional paper forms.
In-network credentialing does come with certain responsibilities however. You cannot disclose billing codes, reimbursement rates, your clinic must comply with site reviews, on-site visits, examination of records, and you must maintain proper documentation and reporting.

The Process

The process to get credentialed to provide mental health care services, which includes Autism Spectrum Disorder (ASD), is by no means an easy route. But we can lead the way and help get you credentialed quicker, which means working with patients sooner.

The first step to become credentialed is to apply for a National Provider Identifier (NPI). This requires for you to complete an online application where you will need to input your social security number and/or EIN (Employee Identification Number), BCBA or BCaBA certificate number, BA License number (if applicable), and the taxonomy code for a behavior analyst (103K00000X). Obtaining your NPI usually occurs in less than a day and is required in order to receive reimbursement for ABA services with any carrier.

The Council for Affordable Quality Healthcare (CAQH) is the second step in the credentialing  process, and because it requires more time and paperwork, the agency actually suggests hiring reliable support – like Amvik Solutions – to help clinics get through this portion of the process. In order to become a part of CAQH you must be invited by an insurance company. Once you are able to log in into the CAQH  system, you will be required to provide a bevy of information including: references, employment history, information about your practice/facility, educational history, proof of professional liability coverage, resume, W-9, BCBA/BCaBA certificates, licenses you may have, and more.

Once the application has been completed, insurance companies will be able to access this information in order to verify credentialing with their agency. However, it is important to remember that there may be additional requirements the insurance company sets on their end.

How Long Does Credentialing Take?

The entire credentialing process can take anywhere from 90 to 120 days to be completed. If you are starting your own practice, it is highly recommended that you initiate the credentialing process as soon as possible because of the length of time it can take.

It’s also important to recognize that the process will include 45-minute calls, essentially each day, throughout the entire duration of the process. Undoubtedly, your time is precious and energy should be focused on the more important aspects of your business, namely, your patients.

Outsourcing with a ABA therapy billing and credentialing service will make it much more time efficient for you and help speed up the process.

What Else Should My Clinic Know?

It’s important to recognize that insurance companies have a variety of plans and every individual family will have different terms of coverage. You should familiarize yourself with patients’ plans and coverage, and track information such as policy effective date, provider reimbursement rates, and deductible amounts.

Before starting services, a best practice is to inform clients about copays, deductibles, and yearly or lifetime caps. Providing them this information is vital, as services can get to be costly for a family, and you do not want to surprise them with additional costs.

It’s also imperative to capture critical information about a patient’s ABA coverage, thus you should consider creating an insurance verification form. Information to gather should include name, date of name, date of birth, address, social security number, name of insurance company, phone number for the insurance company, group number, policy number, plan type, policy holder’s name, employer, and the patient’s relationship to the policyholder. Intake forms and signature forms for HIPAA are crucial and can be the cause of fines against your clinic if you are not taking notice.

Go through the credentialing process error-free with WebABA.

It is important to make sure that all information is correct when submitting applications, as errors will obviously lead to time consuming delays. By collecting all the necessary information through a “Provider Enrollment Questionnaire”, and filtering all relevant data and required documents, we’re able to help you get on the road to being credentialed – reducing time and stress.

Taking certain business responsibilities into your own hands can work for numerous tasks, but credentialing should not be one of them. By helping your ABA agency get credentialed, WebABA will increase your reach and ability to provide the best quality mental health care to those who need it most.

Need help getting started with the credentialing process? Contact us today at 805-277-3392.