Authorization Management

We’re on a mission to make

”write-off“ the bad word it should be.

There’s complexity to ABA authorizations. Is auth required for initial assessment (cpt code 97151)? How about direct treatment (97153)? Does it matter if it’s a Medicaid vs. commercial insurance company? If the child has an autism diagnosis or not? Or a different diagnosis? How far in advance do they need to be submitted to ensure coverage? Does insurance back-date these requests?

If you provide critical mental health services (diagnostics, speech language pathology, occupational therapy, counseling, etc.) – particularly in conjunction with ABA – the complexities multiply.

Let us deal with these critical issues that could otherwise drive you crazy. We’ll obtain prior authorization for every service that needs it, every time. So you can stop fretting about your authorizations and focus on the clients you serve.

Putting the ”customer“ back into ”customer portal“

Are you sick and tired of logging into multiple systems that feel like they were designed by Frankenstein? Our easy-to-use customer portal makes it simple for your BCBAs to track authorization deadlines, insurance requirements and much more. Just one more way we’re helping you rest easy at night.

Appeals: we go to bat for you and for your families

”You have been approved for 15 hours per week.“

These are dreaded words from an insurance rep after you’ve requested 30 hours. It raises so many questions: was this an actual denial? If so, where’s the documentation? Can the decision be appealed? What’s the process? How long will it take? With a client in desperate need of life-changing services, can treatment be provided under continuity-of-care guidelines during the appeals process?

You focus on changing children’s lives. We’ve got this.

Check out the Council for Autism Service Providers’ (CASP) ”Health Insurance Appeals Guide.”

Insurance education to empower you

The ABA Coding Coalition has developed a “Model Coverage Policy” for adaptive behavior services. This is the type of information critical to advocating for families’ rights to coverage and the medically necessary amount of services … in addition to a providers’ responsibility to meet rigorous legal, compliance, and integrity standards. We’re sharing it as part of our commitment to empowering and educating ABA providers in our field.

ABA Coding Coalition,

September 2020

The purpose of this model coverage policy is to help providers of ABA services communicate with payers about appropriate coverage determinations, including indications, limitations, and competence recommendations.Providers may use this document in conversations with Medicaid, Medicare, TRICARE, and commercial payers.