top of page
  • Writer's pictureNicole Eugenio

Behind The Scenes: Credentialing, Benefits, and Initial Authorization

In order to provide as much transparency as possible, we’d like to give you an overview of the credentialing process that occurs with each insurance company that we work with as well as more information regarding your benefit check process and initial authorization request.


Credentialing:

Your Way ABA is proud to be an in-network provider. By being in network with most major commercial insurance companies, we are able to offer you the most affordable rates possible for your services. Many insurance plans still require either a copay or coinsurance for each session that occurs, though we are happy to set you up with a payment plan that you are comfortable with if needed.

The first step of gaining in-network status with each insurance company is an application. All information regarding the company is provided to the insurance company as well as information regarding each provider (BCBA) that is to be credentialed. The insurance

company will review the information about the company and the BCBA including the BCBA’s credentials, education, etc.


Please note that the credentialing process does vary slightly between each insurance company and that each company’s processing times does differ. Additionally, if you do not see that we are in network with your insurance company, please don’t hesitate to reach out as we are happy to credential with additional insurance companies.


Benefits Check:


Once we are in-network with an insurance company, we are able to begin working with families who have an insurance policy through that company. The first step is completing a benefits check. To do this, Your Way ABA will need a prescription for ABA therapy from your child’s doctor, a copy of the front and back of the child’s insurance card, and a diagnosis document. The diagnosis document should include the result of diagnostic testing for Autism Spectrum Disorder (ASD) showing ASD as a diagnosis as well as the tests that were completed that led to that diagnosis, if possible. If you are able to obtain the document with the specific tests, that usually helps to speed up the process, but if you only have the results, we can attempt to request an authorization for services with only that, though often times, the insurance company will request this.


Once we have confirmed your benefits and have been told by your insurance company that ABA is covered under your policy, we can request an authorization for services.


Initial Authorization Request:


To request an authorization, we will submit your ABA prescription and diagnosis document to your insurance company along with our request for assessment hours. The amount of hours approved for assessment may vary slightly by insurance company, but typically falls within the range of 8-12 hours.


Once we have received the initial authorization approval, your BCBA will reach out to schedule your initial assessment.

44 views0 comments

Recent Posts

See All

Comments


bottom of page