Congratulations! You’ve made the decision to take the leap and start your own applied behavior analysis (ABA) therapy clinic. As a first step, you have already started the payer contracting process. Almost immediately, the first payer you contact lets you know that you need to go through a credentialing process. Understanding ABA clinic requirements, including credentialing and contracting, is essential to getting your practice up and running. What’s involved with that?
Ready to Get Credentialed?
One of the critical steps in establishing your new clinic involves navigating the payer credentialing and contracting process. Being organized and doing this the right way for your very first payer is crucial as it allows you to partner with insurance companies, making your ABA therapy services accessible to a broader range of clients and ensuring that you receive timely payments for services rendered. Here’s a step-by-step guide tailored for new BCBA clinic owners entering the world of ABA insurance credentialing.
Understanding ABA Credentialing
ABA credentialing is the process by which insurance networks assess and verify a healthcare provider’s qualifications and professional standing. For any new ABA practice, it is a critical step that directly impacts your ability to bill through insurance—an essential component of your business model and growth.
It serves as the gateway to working with insurance companies and ensuring timely payments for your services. Without it, your clinic won’t be able to accept insurance, limiting access to potential clients. This makes ABA credentialing a cornerstone of a successful ABA therapy practice.
More than just paperwork, credentialing and contracting establish your clinic’s credibility, expand your payer network, and secure a steady revenue stream. By being credentialed, you open the door to serving a broader range of clients, accessing higher reimbursement rates, and reducing the administrative burden on your clinic.
The Credentialing Process at a Glance
Getting credentialed may seem overwhelming, but breaking it down into clear, actionable steps can make the process much more manageable. Once credentialed, you’ll become an in-network provider, significantly expanding your clinic’s reach and appeal to clients seeking ABA services covered by their insurance. Below are the key stages you’ll go through to become credentialed with payers and start billing insurance effectively.
Step 1: Prepare Your Documents
The specific ABA clinic requirements are document-intensive, requiring you to provide detailed professional information. Here’s a checklist of what you might need:
Professional Resume: Detailed and up-to-date.
Copies of Licenses: Including your BCBA certification and any other relevant state or professional licenses.
Proof of Insurance: Malpractice and liability insurance certificates.
Tax Identification and National Provider Identifier (NPI) Numbers: Ensure you have these identifiers ready.
References: Typically, three professional references are requested.
Having these documents prepared in advance can significantly speed up the credentialing process.
Step 2: Choose Your Payers
Decide which insurance companies you want to work with. Consider factors such as which insurance carriers are popular in your area, the ease of dealing with specific payers based on other ABA providers’ experiences, and the rates they offer. When choosing an insurance company, assess their reputation for processing claims and their level of customer support. Once selected, contact each payer to obtain their credentialing and contracting application and details about the process.
Step 3: Complete Application Forms
Fill out the ABA insurance credentialing application forms thoroughly. Any inaccuracies or omissions can delay the process, so it’s crucial to double-check all entries. Submit the required documentation as specified by the payer. This often includes submitting copies of your licenses, resume, proof of insurance, and ensuring you understand any pre-authorization requirements specific to ABA services.
Step 4: Follow Up Regularly
After submitting your applications, proactive follow-up is essential. The process can take anywhere from 90 to 180 days, and sometimes longer. Regular follow-ups help ensure that your application is being processed and can help identify any issues early on.
Step 5: Review and Negotiate Your Contracts
Once your ABA insurance credentialing application is approved, you’ll receive a contract from the payer. Review this contract carefully, possibly with legal assistance. Pay attention to rates, the services covered, and other obligations. If necessary, negotiate terms to better suit your clinic’s needs.
How Long Credentialing Takes
Tips for speeding up the process:
Organization: Keep all your documents organized and readily accessible.
Accuracy: Ensure all information is accurate to avoid back-and-forth corrections.
Professional Help: Consider hiring a credentialing specialist to manage the process.
Contracting vs. Credentialing
Understanding the distinction between credentialing and contracting is essential for successfully navigating the insurance landscape. Credentialing establishes you as a qualified provider, while contracting solidifies your relationship with the payer, allowing you to officially become an in-network provider eligible to bill for covered ABA therapy services. While both are crucial steps, they serve different purposes in your journey to establish an ABA practice.
Credentialing: This is the process where insurance providers verify your qualifications, licenses, education, and professional history to ensure you meet their standards for providing care to their members. Each insurance company has its own set of credentialing requirements, which makes careful preparation critical. Credentialing is a necessary first step to demonstrate your eligibility to work with specific payers and to bill for services.
Contracting: Once credentialing is complete, the contracting phase begins. This is when you negotiate and sign an agreement with the payer. The contract outlines your reimbursement rates, covered services, and the terms of your relationship with the insurance company. Contracting is the final step that enables you to bill the insurance payer for your services.
In short, credentialing confirms your professional qualifications, while contracting formalizes the terms of your partnership with the payer. Credentialing must be completed first, as you cannot sign a contract or bill payers until you are credentialed.
Laying the Foundation for Your Success
Getting through ABA insurance credentialing is one of the first major hurdles you’ll face as a new BCBA clinic owner. While it can be time-consuming and sometimes frustrating, it’s a crucial step in setting up a successful ABA practice. By understanding and meeting key ABA clinic requirements, like credentialing and contracting, you ensure your clinic is positioned for long-term success. With careful preparation, organization, and persistence, you can navigate this process effectively, laying a solid foundation for your new clinic.
Starting your own clinic is no small feat, but with the right approach to credentialing requirements, you’re paving the way for a thriving practice that can make a significant difference in the lives of many.
Take the Next Step with Confidence
When you choose to start your ABA therapy clinic, know it is a bold and rewarding journey, and mastering the payer credentialing and contracting process is a crucial step toward success. By becoming in-network, your clinic will be positioned to offer accessible ABA therapy services to families who rely on insurance coverage, ensuring more clients can benefit from your expertise. With the right tools and support, you can streamline the process, save time, and focus on delivering exceptional care to your clients.
At Raven Health, we make the administrative side of your practice easier. From ABA insurance assistance to streamlined billing solutions (including navigating billing codes), our platform is designed to support you at every stage of your clinic’s growth, so you can provide services that truly make a difference. Ready to get started?
Welcome back to our blog series tailored for BCBA entrepreneurs embarking on the journey of opening their own ABA therapy clinics. Having covered the basics of payor contracting and credentialing in our previous posts, today we focus on another essential topic: the client enrollment process with payors. This process is vital for ensuring that your clients are covered under their insurance plans for the services you provide, which in turn secures your clinic’s revenue stream and supports financial stability.
Understanding Client Enrollment with Payors
Client enrollment with payors is the process through which your clients’ insurance coverage is verified and authorized for the services offered by your clinic. It involves confirming that the services you provide are covered under the clients’ health insurance plans and understanding the terms of coverage.
Why is Client Enrollment Important?
Properly enrolling clients with their respective payors ensures that:
Your clinic can bill for services rendered without facing denials for lack of authorization.
Clients receive their entitled benefits, which enhances client satisfaction and retention.
Your clinic maintains compliance with insurance regulations and payor contracts.
Tips for an Efficient Client Enrollment Program
Leverage Technology: Use practice management software that supports insurance verification and authorization tracking. Many systems like Raven Health offer integrations with major insurance databases to streamline verification, authorization tracking, and more.
Train Your Team: Ensure that your front office staff is well-trained in insurance verification processes and client communication. They are often the first point of contact and play a critical role in the client enrollment process.
Stay Informed: Keep yourself updated with changes in insurance policies and healthcare regulations that affect ABA therapy coverage.
Create a Client Welcome Kit: Include information on how clients can verify their own coverage, terms of their insurance, and FAQs about ABA therapy coverage, which can preemptively answer many client questions.
Conclusion
Client enrollment is a crucial step in managing your ABA therapy clinic’s operations effectively. By ensuring that your clients are properly enrolled with their payors, you safeguard your clinic’s ability to operate profitably while providing necessary services to your clients. Stay tuned for more insights in our next installment, where we will explore strategies to enhance client engagement and satisfaction in your clinic. Remember, an informed approach to client enrollment not only supports your business’s bottom line but also enhances your service delivery, contributing to the overall success of your ABA therapy clinic.
Data-driven decision-making is at the core of Applied Behavior Analysis (ABA). Technology advancements continue to shape how behavior analysts and other ABA professionals approach client care. Traditional pen-and-paper documentation is steadily giving way to innovative digital solutions. Using technology for data collection improves accuracy and efficiency and allows behavior analysts to more rapidly make data-driven decisions to improve client outcomes.
Importance of Data Collection for Children with Autism
The vast majority of ABA clinicians, over 70%, work within the autism population (BACB). Each child is unique and requires individualized, data-driven care. As such, ABA clinicians know the importance of accurate and efficient data collection for driving the best possible outcomes. Data enables behavior analysts to develop tailored interventions based on a client’s needs, track progress, analyze trends, and make data-informed modifications about their progress on an ongoing basis. Data is crucial for assessing the effectiveness of interventions and ensuring clients progress toward their long-term goals.
How to Improve Data Collection with Technology
While many options exist for collecting ABA data, technology-based methods have emerged during the current digital age. Utilizing technology for data collection comes with many advantages. By using a data collection software that is tailored to the unique needs of ABA professionals, organizations can improve client and staff outcomes, resulting in improved quality of life for clients and higher job satisfaction for staff.
ABA organizations can improve their data collection methods by adopting digital-based data solutions. Some of the benefits of transitioning to a technology-based data collection method include:
Reduced chances of human error – Improved accuracy is one of the primary benefits of digital data. When using paper data, technicians may be unable to immediately enter data, resulting in data entry several minutes after the observation, reducing accuracy. Digital data collection allows staff to seamlessly enter data in real-time, which reduces the chances of staff forgetting the correct information and thus entering inaccurate data. Entering data only once, rather than transferring paper data to another system, also reduces the likelihood of human error.
Increased efficiency – Digtal data platforms allow technicians to enter data immediately upon observation, saving time and allowing technicians to focus more of their attention directly on their clients rather than being bogged down with paperwork. Digital data also makes session note writing effortless, allowing technicians to end each session with a well-written, concise note.
Streamlined data analysis – With real-time data submitted electronically, behavior analysts can readily analyze data, allowing them to make well-informed, data-driven treatment decisions. This all leads to more effective and individualized interventions.
Enhanced security and privacy – Digital ABA data also enhances the security and privacy of client data when using a HIPAA-compliant platform. All client data and session notes are housed in one secure location rather than on numerous data sheets that can be lost or misplaced.
Ease of use – In a fast-paced therapy session, carrying around a clunky clipboard or binder and scrambling through data sheets can be a challenge. Using a phone, tablet, or other compatible device, a technician can efficiently move about the session and seamlessly enter data as the session progresses without missing anything. Whether chasing clients around their homes or working out in the community, digital data makes this much more manageable.
Increased compliance – Maintaining records in one secure location increases compliance with laws, funding requirements, and regulatory bodies.
Why Are Some ABA Professionals Still Using Paper?
Despite the countless benefits of technology-driven data collection, some ABA clinicians still cling to paper-based and other disintegrated methods. This reluctance to transition to digital data collection often stems from a pre-existing comfort with using one’s current system. While paper data collection is less efficient and comes with other challenges, such as increased proneness to error and risk of non-compliance, change can be difficult to accept. Some behavior analysts may continue to use paper data because they feel it has worked well enough for them thus far. Likely, many are simply unaware of the available ABA data collection solutions and their benefits.
Other reasons ABA professionals may avoid adapting to digital data collection may be concerns regarding technology complexity, a lack of time to learn new methods, and the costs associated with digital platforms.
At Raven Health, we recognize the concerns many ABA clinicians have with transitioning to digital data collection. As such, we are committed to making the switch as seamless as possible.
Raven Health’s Mission to Equip the ABA Industry
Raven Health enables behavior analysts to harness the power of data collection effectively. With innovative software tailored for ABA, clinicians can improve client outcomes while improving staff satisfaction.
Schedule a demo today to see our platform in action and learn more about how we’re improving care through technology.
ReferencesCooper, J. O., Heron, T. E., & Heward, W. L. (2019). Applied Behavior Analysis (3rd Edition). Hoboken, NJ: Pearson Education.
As an ABA clinic director, managing your clinic can be a challenging task. From scheduling appointments to tracking client progress, there’s a lot to keep track of. Fortunately, Raven Health offers a mobile-first platform that is designed to make your life easier.
Five reasons why ABA clinic directors love Raven Health
Mobile-first platform
Raven Health’s software is designed for use on mobile devices, making it easy to manage your clinic from anywhere. Whether you’re working from home or on-the-go, you can access all of your clinic’s data and manage your schedule with ease. This flexibility is essential for clinic directors who are always on the move.
Scheduling made easy
With Raven Health, scheduling appointments is a breeze. You can easily view your team’s availability, schedule new appointments, and send reminders to clients and staff. This makes it easy to stay organized and ensure that everyone is on the same page.
Intuitive interface
Raven Health’s interface is designed to be user-friendly and intuitive. You can quickly find the information you need, customize your dashboard, and easily navigate the software. This makes it easy for new users to get started and for experienced users to quickly find what they need.
Security and compliance
Raven Health takes security and compliance seriously. Their software is HIPAA-compliant, and they use advanced security measures to protect your clinic’s data. This ensures that your clients’ information is protected and that your clinic is in compliance with all relevant regulations.
Reliable data collection
Raven Health’s data collection tools are reliable and easy to use. You can easily record and track client progress, generate reports, and share data with your team. This makes it easy to stay on top of your clients’ progress and to make informed decisions about their treatment.
Conclusion
In conclusion, Raven Health provides ABA clinic directors with a comprehensive solution that offers a mobile-first platform, easy scheduling, intuitive interface, and secure data collection. By choosing Raven Health, you can simplify your workflow, manage your clinic more efficiently, and provide top-quality autism behavior therapy for your clients. With its user-friendly interface, reliable data collection tools, and advanced security measures, Raven Health is an excellent choice for any ABA clinic director who wants to streamline their clinic’s operations and improve their bottom line. Give Raven Health a try today and experience the benefits for yourself.
Billing shouldn’t be complicated, but with so many options out there it can be. Managing billing needs to be straightforward and streamlined, which is why we created Raven+ and Raven Enterprise. Our comprehensive solution is designed to help you maximize efficiency and increase your profitability without all of the hassle. With a streamlined process, independent auditing services, and accurate reporting, you can rest easy knowing that your billing needs are being met.
Launching Your ABA Startup
As a BCBA working in the ABA community, your day-in and day-out goal is to provide the highest quality and ethically sound care you can. The years spent training and studying have prepared you to do just that.
For some, the desire to have a greater impact on the community they work with leads them to make the brave decision to go out on their own, hang up a shingle, and open their own ABA company.
For most, it is not an easy decision to arrive at. It can be a scary road to take, as there are many things to consider beyond just the delivery of high-quality clinical care.
Avoiding Audits, Claim Denials, and Other ABA Hurdles
The transition into being a new business owner after working as a BCBA, Clinical Director, or even in a senior clinical leadership role, can feel overwhelming.
There are so many areas of running a successful business that you may not have been exposed to in your previous role. Just to get your business started, there are myriad legal steps to complete, specific types of insurance to acquire, and financial relationships to develop.
Once you have taken the initial steps to establish your business, you must contract and credential with the funding sources you plan to work with. This can be a complicated and timely process that, if not done correctly, can lead to delays in starting treatment with clients, delays in claims payment, and even claims denials.
It is imperative that this process is done correctly, to ensure timely access for clients and ease of payment for you.
Maximizing the Right Tools: Raven’s Managed Billing Solution
When it comes to the claims process, you have a few options: you can attempt to do it yourself, hire someone to come in and do it for you, or you can outsource this process to experts that will work on your behalf to ensure you get the payments you are entitled to, as well as keep you safe from audits. With Raven’s managed billing solution, our network of specialists can take care of the details and eliminate the hassle, so you can focus on what really matters.
Raven+ and Raven Enterprise offer solutions to fit your needs. Let the Raven team handle to the complicated process of contracting, credentialing, authorization submission and management, benefits verification, claims scrubbing, and claim submission.
Raven allows you to focus on what you do best as a clinical team, and we handle the rest.
At Raven, one of our guiding principles is active listening. Our company culture is built around the idea that everyone has a voice that deserves to be heard, and we all have something of value to contribute. Serving the autism community has taught us that voices from diverse backgrounds add insight and nuance to our collective knowledge.
Without actively listening to new perspectives, we close ourselves off from creativity and positive change. That is why we extend our core value of listening to our user base. Our product was built for behavior technicians, and we recognize that we have so much to learn from the people in a position to use Raven every day.
Incorporating feedback, requests, and insights from the people we aim to serve ensures that we stay on track and deliver a best-in-class product that is tailor-made to meet our users’ needs.
The Raven Health User Feedback Portal
Our app was designed to save time and add convenience for autism behavior analysts as they track the behaviors and skill development of their clients. In addition to the features you know and love, we are proud to operate and maintain a user feedback portal that is integral to the process of learning, using, and updating the Raven Health app.
On the feedback portal, Raven users can request new features, and enhancements to existing features, as well as upvote other users’ requests. Every two weeks, the topmost upvoted requests are directly analyzed by our product team for inclusion into our roadmap for new developments and updates to the platform. All you need is Raven Health log-in credentials to begin contributing to the conversation and helping us further develop the app.
In addition to the Roadmap View and the ability to give feedback, the user feedback portal also has a changelog where you can read about all of the updates we have made to the product thus far. Our goal is to keep our users in the know about the changes they can expect to see from Raven and keep ourselves accountable to our goal of continuously improving the platform.
Why User Feedback Matters
Prioritizing user feedback ensures that Raven stays true to the needs of our user base and incorporates the latest trends and advancements in the ABA therapy field. We can identify commonalities in user needs across a variety of settings and push those features to the forefront of our development. Raven incorporates feedback from users based in a wide array of settings including clinic-based ABA therapy providers, school-based BCBAs, and adult residential programs, ensuring that user experience always drives our product development.
As we navigate the landscape of an underserved client base, Raven prioritizes listening to our users to continuously improve our product. Doing so helps us make sure that ABA providers are benefiting from using the best technology out there. These benefits are wide-reaching, as every part of the behavior therapy business depends on diligent and seamless ABA data collection for billing insurance, measuring progress, and planning future care.
Our product development has always been informed and guided by BCBAs. Whether you deliver clinic-based care, school-based care, or operate a private practice, we want to hear from you as you use Raven to fulfill your ABA data collection needs. Our commitment to listening and incorporating user feedback is central to our vision of success: delivering an ABA technology solution that makes life easier for our users.
