5 things to consider for BCBAs providing ABA Therapy service before applying and the basic steps to follow when applying for In Network status with some national plans. After you have completed your CAQH application, what’s the next step? Review these 5 items to consider and follow the introductory steps to start down your path to becoming an In Network provider with some of the national plans. Completing these applications will help prepare you for your local plans with more specific or enhanced criteria.
Things to Consider:
#1—Are you going to apply as a Group or Individual?
If you are planning to grow your business and have multiple ABA Therapy providers, you may want to consider starting your credentialing and contracting process as a Group from the start. It can be a delayed process to change from Individual to Group if you make the decision later on.
For Group applications, you will need a Company Tax ID and a Group NPI.
#2—Research the requirements of each Insurance company to pick the ones you want to get started with.
Here are a few examples:
Local BCBS
- Do your homework on what the requirements are for your state.
- Some states will only credential Licensed Providers.
- Some Anthem states are not accepting new ABA providers.
United Behavioral Health
- Review their website for states where they are not accepting new ABA providers (at the time of this blog California and Texas are listed) or states with only certain counties available.
- The link above for the UBH ABA Corner is also filled with information on how to prepare for the UBH audit.
- UBH is currently making changes to their process to credential BCBAs specifically rather than the provider facility as a whole as they have done in the past. This is consistent with other plans.
Cigna
- Minimum requirements for group credentialing consideration
1. At least 10 Providers
2. At least 1 State Licensed Psychiatrist
3. At least 1 State Licensed Psychologist - If the applicants do not meet the minimum requirements, they can credential individually under the Company Tax ID.
- Autism Resources and Information
Aetna
- Aetna credentials both BCBAs and BCaBAs.
Tricare
- Spend time reading through the Tricare information for your region and familiarizing yourself with their specific requirements.
- Each of the 3 Regions is managed by a different group.
- Tricare credentials RBTs (Registered Behavior Techs) study up on all the requirements necessary for this credential.
#3—Determine your Fee Schedule
You need to have a Fee Schedule in place before starting to negotiate with insurance companies. That Fee Schedule is your published rates if asked in an audit and needs to be the exact same Fee Schedule that you discuss/present to all insurance companies. Regardless of what insurance companies offer as their reimbursement rates, you need to place a value on your services before getting started.
- Keep in mind that some contracts will pay a % of billed (Fee Schedule), but most will negotiate specific rates for the ABA codes.
- Please note: you are allowed to have a Cash Discount private pay Fee Schedule, but this also needs to be fair and consistent to all private pay families.
#4—Credentialing and Contracting are two different steps
You must complete the credentialing process before you can expect a fully executed contract. Two different departments handle credentialing and contracting. Even if you simultaneously receive a contract for review and signature or a code and rate sheet for negotiation, you are not In Network until the entire process is completed.
#5—Examine your Contract in detail
Look for specific information related to Supervision requirements and whether Supervision and Tech hours can be billed at the same time (overlaps). If not, be sure to negotiate your rate for codes that cover Supervision to cover both providers if at all possible. This will help you in your business planning for costs that are non-billable.
Seek details on how to submit claims, such as where/when to include the Rendering provider and Group information. This will help you avoid denied claims up front for incorrect billing.
Getting Started—Basic Steps
Here are the first basic steps for some of the national plans.
Aetna
- Aetna Behavioral Health Application
- With this application, they will access your CAQH, so be sure that it shows Aetna is allowed to see your data. You may have to go back in and authorize their access if you get notice that they cannot see your application.
Cigna
- Autism Specific Screening Form
- Review the Autism Resource link from above.
UBH
- FAQs for ABA from UBH
- Network Managers by State
- For all other states (not listed above), please reach out to the appropriate Network Manager by email to request participation. Include basic demographic information about your group (i.e., name of group, address with city and state, and service area). Note that there could be areas within each state where they do not have geographical needs and you will be notified upon receipt of your request for participation. (from Provider Express ABA Corner)
At this time, you may also consider requesting help from a third-party agency that specializes in Credentialing. Agencies like ours can spend the necessary focused time ensuring that all the application requirements are met, can perform the consistent follow up to bring your application to completion, can negotiate rates on your behalf, and can finalize your contract with each insurance company—all while keeping you updated and involved in the process where needed.
If you would like to know more about how we can help you through the In Network credentialing process, email us now or give us a call at (520) 800-4740 and we can talk about how we can help you reach your goals.
We hope these tips are helping you get started on your way to working with insurance companies for the ABA Therapy services that you are providing to the Autism community. Let us know your thoughts and how else we can help!
