5 Tips for Credentialing your BCBA

For ABA practices, credentialing your Board Certified Behavior Analyst (BCBA) is a crucial step. Without this authorization, a therapist will be unable to provide insured services. This restriction severely limits the number of patients who will engage with the physician. 

Unfortunately, credentialing offers many potential pitfalls. ABA practices have dozens of ways to fail the credentialing process. Learn what habits satisfy insurance agencies to avoid this failure. 

Here are five tips for credentialing your BCBA.

Documentation Requirements

Insurance companies vary in their documentation standards. Requirements regarding CPR training and RBT certification differ. While all insurers demand a background check, the depth of the investigation is inconsistent. To satisfy the requirements of as many payers as possible, do an in-depth background check as part of your hiring process. Doing so ensures that you have this information on hand, if needed. 

Apply to the Council for Affordable Quality Healthcare (CAQH). CAQH gives users access to a vast database connected to participating healthcare networks and plans. After uploading your documents into the database, insurance payers can retrieve your education, certification, and other information. 

A common problem is an issue with CAQH visibility. Instruct your providers to maintain and update their CAQH accounts so insurers can easily access their data. Also, your therapy providers should have resumes that list exact dates of certification and employment. 

Contracting Vs. Credentialing

During the transition to in-network status, credentialing paperwork and contracts often pile up, making it easy to confuse the two. However, it’s important to remember the distinction between these processes. A contract lays out the terms of service between your healthcare practice and the insurance agency. Credentialing is the review of a therapy provider’s credentials, necessary for insurer approval.

The contract is a documented agreement between your practice and a payer. By contrast, your organization must credential every new therapy provider it hires. Avoid thinking you have permanently completed paperwork once you've finished the initial batch. 

Maintaining Credentialing

The more your practice grows, the more helpful it is to maintain a tracking system for your credentials. When juggling an expanding practice’s requirements, it’s easy to let crucial details slide. To prevent this regression, your staff should consistently monitor specific items. 

Credentialing has an expiration date. Depending on the payer, they will require re-credentialing or re-validation for an individual or group. Most payers will notify the practice of re-credentialing before the renewal date. Following this notification, practices must act quickly to avoid missing the deadline. 

Handling Therapy Providers 

During the application process, therapists will receive no money from payers. Coordinate their training to coincide with this waiting period. Therapists of any experience can work with out-of-pocket patients during the interlude. Waiting physicians may also complete non-billable BCBA services.

Time Restrictions

Credentialing takes time. Typically, the process lasts from 90 to 150 days. Timelines for group and individual applications vary and are dependent upon each payer. Some payers require a minimum number of providers before credentialing a group. The more providers you have, the more you should consider a group option. 

If your ABA practice feels uncomfortable sorting through billing and coding paperwork, consider hiring a professional billing service. Plutus Health helps clinics avoid denials and maintain a consistent revenue flow. Our team works to cut through delays and get you the fastest reimbursements possible. 

Key Takeaways

1. Understand what documents you’ll need and prepare them as early as possible. 

2. Know the difference between credentialing and contracting to avoid confusing paperwork. 

3. Stay aware of re-credentialing or re-validation deadlines. 

4. Schedule therapists to work non-billable BCBA services during the credentialing wait. 

5. Plan before committing to an individual or group agreement.