ABA Startup Bootcamp: Payer Credentialing Process 101
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. 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 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. 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?
Start your free 30-day trial with Raven Health today and experience firsthand how we can help you build a thriving, efficient, and successful practice.
