What is a payer in ABA?
A payer is the organization responsible for reimbursing healthcare providers for covered services — in ABA, typically a private insurance company, a Medicaid managed care organization, or a government program such as Medicaid or TRICARE.
Every payer sets its own rules. Credentialing requirements, billing rules, authorization processes, and documentation standards all vary, which is why the same service can be handled differently from one payer to the next.
Most practices contract with several payers, so staff track multiple sets of requirements at once. A client's plan determines which rules apply to their sessions, authorizations, and claims.
Knowing each payer's expectations up front is what prevents avoidable denials, and it is why credentialing, authorization tracking, and billing are usually managed together rather than as separate workstreams.