Credentialing challenges can be one of the top reasons your clinic is not getting paid. A single BCBA credentialing issue can affect a dozen clients under their caseload, leading to potential service gaps — affecting your client families — and $50-100K of denials that may never be recouped. New and growing clinics encountering payer contracting and credentialing delays also risk losing families that often need services to be in-network with their insurance. On the other hand, taking proactive steps to address credentialing challenges mitigates these risks, ensuring consistent and cohesive services for your client families and strengthening your financial position. We’ll show you those steps. While the topic of credentialing can include many different aspects — such as site credentialing for safety and accessibility, and provider certification credentialing — this article will focus on payer contracting and credentialing when you decide to be in-network with various insurance funders and credential your providers with each of them.
How to Credential Effectively in your ABA Practice
We’ve collaborated with ABA credentialing expert Anna Bullard, the current VP of Operations at Accelerated Delegated Credentialing and VP of Government Relations at the Behavioral Health Center of Excellence, who shares insights from her decades of experience in the field and collaborations with clinic systems across the U.S. Here are practical strategies to guide your credentialing journey:
Contracting and credentialing with a new insurance payer takes months — start early
Our experience partnering with dozens of practices, from local clinics to national clinic systems, continues to show that early attention to and front-loading of your credentialing function is crucial for streamlining your clinical operations and driving overall financial success.
Contracting and credentialing with a new insurance funder requires anywhere from 3-6 months for payer verification to complete the contracting process. Credentialing staff and ensuring the contract is properly set up for billing can take another 1 to 2 months. Waiting until the last minute, when patient intake is imminent, can result in months-long delays in receiving reimbursements, significantly hampering cash flow while you continue to spend on payroll and maintaining service.
Make sure all of your company information is consistent including legal name, tax ID, group NPI and banking information to ensure the most efficient timelines. In the case that documentation is submitted incorrectly or with missing materials, the resubmission can take an additional 30 or more days, further impeding progress.
Proactively tackle credentialing with multiple popular insurance funders in your region, as the initial time you take up front is worth the investment down the line.
Gather CAQH documentation thoroughly
Start by compiling all the necessary documentation for your providers’ CAQH applications. Audit, update, and re-attest to ensure new credentialing applications are not denied due to CAQH errors. For existing providers, ensuring the CAQH is maintained is a critical component to reducing billing and authorization issues. Effectively organizing and storing these materials expedites there- credentialing process too. It is important that companies have a system for tracking payor requirements for providers such as the CAQH to ensure providers are not termed from the network. Anna Bullard has developed a comprehensive checklist at ADC, which utilizes a secure credentialing platform to organize, store and track provider information for re-credentialing, to ensure efficient and accurate documentation. We’re making an excerpt available here for your reference, and you can get in touch with Anna on her website here for more information.
· Certificate of Insurance
· Disclosure of Ownership
· Tax ID
· Group NPI
Individual Provider Checklist:
· CAQH updated with company information
· Active License/Certification
Remember, the name of the game is swift and accurate credentialing. Incomplete or expired document submissions can be as detrimental as not pursuing credentialing at all.
Follow-up on the credentialing process with your payer representatives
Maintain meticulous records and diligently follow up on all credentialing submissions. As mentioned earlier, payers typically allow 120 days for document verification. Actively engage with your payer representatives every 1-2 weeks by email or through their appropriate helpline, to get status updates and to make sure nothing has slipped through the cracks.
According to Anna, proactive engagement can significantly speed up the credentialing process. She notes, "We have found that approximately 10-20% of the time, contacting payers for updates or confirmation reveals missing information, lost documents, or overlooked steps. Following up with them helps fill these gaps and ensures a timely process.”
Track dates of credentialing coverage actively
If your practice fails to maintain up-to-date provider documents or overlooks it altogether, it can lead to a backlog when filing claims and seeking reimbursement. This additional burden on billing teams exacerbates delays in revenue collection, and ultimately, impact your bottom line. In many cases, insurance companies will outright deny claims for services with providers causing thousands of dollars of loss.
Make sure to have a tracking system for re-credentialing dates and when additional document submission is necessary. A tracking system can be a simple Excel workbook with various steps to be taken, with a new row for each provider you onboard and columns for every step that’s necessary. Track these steps carefully to make sure they’re completed on time, as this will determine when your providers can begin serving your client families.
Contract in-network with high-demand insurance payers in your region
Limiting your in-network insurance payers or choosing the wrong ones can restrict your prospective client pool and curb your practice’s growth – and could lead to a lot of unnecessary work. Client families who seek insurance-covered services may choose other practices that accept their insurance, resulting in lost opportunity.
Be sure to research the insurance payers in the most demand in your region that may generate high amount of referrals and coverage, and work on getting in-network contracts and credentialing your providers early. Also check that negotiated in-network insurance reimbursement rates are sufficient to sustainably serve those client families with your clinical staff.
Maximizing Returns: The Benefits of Effective Credentialing and Reducing Denials in ABA
Beyond the imperative nature of credentialing, there are numerous benefits associated with its meticulous execution.
Greater patient coverage and retention
Client families who benefit from in-network insurance coverage within a well-credentialed ABA practice are more likely to stay. Establishing trust in your practice's ability to provide consistent, high-quality care is key.
Alleviate Unnecessary Administrative Workload
Properly credentialed practices streamline billing and reimbursement processes, reducing administrative burdens on staff members and practitioners alike. By alleviating the additional workload that comes with improper credentialing, your practice fosters an environment for meaningful work, where team members can focus on treating patients and other critical tasks instead of preventable paperwork.
Fuel growth through in-network referrals
By establishing a robust credentialing foundation, your practice can leverage its positive reputation to expand its client base through client referrals and your listing in insurance company search portals. These satisfied patients become ambassadors, opening doors to further growth and opportunity.
From expanding patient access to ensuring timely reimbursements, mastering the art of credentialing is essential for ABA practices aspiring to deliver high-quality care while navigating the intricacies of the healthcare industry. By recognizing its significance, and learning how to credential effectively, your practice can establish a solid foundation for long-term success.
- Credentialing directly impacts the sustainability and growth of ABA practices - prioritize getting this right for greater patient and team satisfaction, and compliance.
- Quicken the credentialing process as much as possible by front-loading the process, gathering and keeping track of all documentation, and following upon the process with the payer representative every few weeks.