ABA Startup Bootcamp: Navigating Healthcare Payor Contracts

Starting your own Applied Behavior Analysis (ABA) therapy clinic is an exciting venture for any Board Certified Behavior Analyst (BCBA). However, the journey involves a number of critical steps, particularly when it comes to dealing with healthcare payors. Entering into contracts with healthcare payors is essential for ensuring your clinic can serve a wide range of clients, enter into and remain in network with payors, and secure financial stability for your clinic. This blog post will guide you through the necessary steps to successfully contract with healthcare payors and highlight strategies to expedite the process.

Understanding the Contracting Process

The process of entering into a contract with a healthcare payor can be intricate and time-consuming, often taking several months to complete. Here are the key steps involved:

1. Credentialing and Enrollment
   • Credentialing: This is the first step where the payor verifies your qualifications (including licensing), experience, background, and legitimacy to provide healthcare services. This process can take anywhere from 90 to 120 days.
   • Enrollment: Once credentialing is approved, you proceed to enrollment, which involves getting set up in the payor’s system to submit claims and receive payments.
2. Application Submission: Prepare and submit a detailed application to each healthcare payor you wish to contract with. This application should include all required documentation, such as your credentials, licensing information, proof of insurance, and a detailed description of your clinic’s services.

3. Contract Negotiation : Upon accepting your application, the payor will typically send a proposed contract for your review. This stage involves negotiating the terms, including rates, services covered, and other operational details.

4. Contract Execution: After negotiations, both parties will sign the contract, finalizing the agreement. Only after this step will you be able to bill the insurance for covered ABA services.

Tips To Expedite The Process

While the process is generally lengthy, there are several strategies you can employ to speed it up:

• Prepare Comprehensive Documentation: Before you start the application process, gather all necessary documents and ensure they are accurate and complete. This reduces the likelihood of delays due to missing or incorrect information.
• Understand Specific Payor Requirements: Each healthcare payor may have different requirements. Familiarize yourself with these specifics to ensure your application meets all their criteria.
• Follow Up Regularly: After submitting your application, regularly follow up with the payor. This keeps your application on their radar and helps push the process along.
• Seek Expert Help: Consider hiring a consultant or using a credentialing service familiar with the healthcare payor’s processes. They can provide invaluable assistance and potentially speed up the process. They can also be particularly helpful in negotiating better rates, which are critical for stabilizing your clinic’s early financial history.
• Leverage Technology: Utilize electronic submission methods if available, as they are typically faster than paper-based submissions.

Setting Realistic Expectations

It’s important to set realistic expectations about the timeframe for securing contracts with healthcare payors. The entire process, from credentialing to contract execution, can take anywhere from six months to a year. Planning for this time is crucial to avoid financial strain during the early stages of your clinic.

Conclusion

Securing contracts with healthcare payors is a crucial step for any new ABA therapy clinic. While the process is complex and can be lengthy, understanding the steps involved and employing strategies to expedite the process can make a significant difference. With patience, persistence, and careful preparation, you can successfully navigate this journey and set your clinic up for success.