Juniper and The Council of Autism Service Providers (CASP) have created a special collaboration to bring CASP members exclusive access to Juniper's proprietary payor rate data asset.
As a CASP member, you'll be able to view ABA-specific reimbursement rate analyses for one of 40 payors of your choosing within states you provide services.
But what is payor rate data, who can access it, and why does it matter? Learn more about the recent regulation that makes this data available, and how these changing policies are impacting the ABA industry.
We're also looking for your feedback so we can improve this resource for the entire community. Do you see your own rates represented accurately? Please let us know!Get the data Become a CASP Member
Before this ruling in October 2020 (CMS-9915-F), insurance payors were able to use antitrust laws to withhold the rates they paid individual providers from the public. This new ruling mandated that all health plans must share their contracted rates for all providers, starting in July 2022.
While the HHS ruling mandates that insurance payors disclose rate files publicly on their websites, the CMS itself also acknowledges that "specific technology may be needed to download and read these files given their size and complexity" (source).
For instance, UnitedHealthcare maintains ~42K files worth of data, many of which are too large to download onto most personal computers, much less analyze individually.
So while rates are technically available, they're not useful for the vast majority of providers that don't have dedicated technology teams and resources.
Take the graph on the page, which visualizes in-network 97153 reimbursement rates for Aetna in Arkansas.
The X axis gives the maximum reimbursement rate per 15-minute 97153 unit, which ranges from $10.75 to around $19. The Y axis shows the approximate number of NPIs credentialed with that rate. The taller the bar, the more common that rate is for Aetna providers in Arkansas.
From this, we can infer that many providers may be reimbursed up to $33 per hour less than other providers.
These insights can be an asset during the contracting and credentialing process.
Providers can also gain pricing information in neighboring geographies to help strategize how they might best serve certain regions sustainably.
CASP members will be able to select one payor out of Juniper's database of 40+ funders (including Aetna, Cigna, United Healthcare, and Medicaid), and Juniper will provide aggregated data analysis for that payor free of charge.
But our data is only as accurate as insurance payors choose to disclose, and we're looking for your feedback to make it better. Do you know of rates that are not represented in the datasets as expected? Please let us know so that we can improve this resource for all of us in the community.
The Council of Autism Service Providers (CASP) is a non-profit trade association of provider organizations serving individuals with autism spectrum disorder. Learn more at casproviders.org.
Juniper is a technology firm that builds automated, full-service billing for ABA, OT, & SLP providers. Learn more at juniperplatform.com.
CASP is a nonprofit tax-exempt trade association and CASP activities must be conducted in accordance with all applicable laws and CASP policies. CASP's Antitrust Policy requires CASP members to comply with applicable laws, including antitrust laws, which prohibit agreements on price or compensation factors. Please note that the information provided by CASP is presented for general information and educational purposes only. Any information presented is not intended to, and should not, play any role in anticompetitive agreements on price or compensation or restricting competition in the industry or profession. All decisions regarding prices, fees, salaries, or compensation must be made individually and not in concert with others in the industry or profession.
Transparency in Coverage Final Rule Fact Sheet (CMS-9915-F)
Transparency in Coverage (CMS-9915-F)
National Plan & Provider Enumeration System