As we get further into 2025, Applied Behavior Analysis (ABA) therapy providers are facing a period of heightened financial uncertainty. At the center of the conversation are the proposed Medicaid cuts — federal and state-level decisions that could have lasting effects on access, reimbursement, and the operational sustainability of behavioral health services in the United States. While the extent of the cuts has not been finalized, for practices that rely heavily on Medicaid funding, the time to prepare is now.
The Truth About Credentialing Delays: What ABA Providers Should Know in 2025
For ABA therapy clinics across the U.S., 2025 has brought heightened demand, tighter payer controls, and growing pressure to maximize operational efficiency. But amid all of that, one issue continues to throttle growth and delay care: credentialing.
Although credentialing isn’t legally required for all types of billing, it is essential for enrolling providers with payers and enabling reimbursement for in-network services. Unfortunately, delays in the process are becoming an increasingly common threat to cash flow, clinic growth, and patient access. This scenario is all too familiar: BCBAs are hired, their paperwork is finalized, the credentialing application is submitted — and then everything stalls. Weeks pass. Then months. Still no approval. Meanwhile, families are waiting, schedules are in limbo, and clinics are watching revenue slip away.
So, why do they keep happening, and what can ABA providers do to speed up the process? This blog explores the truth about ABA credentialing delays in 2025 and what providers can do to reduce wait times and safeguard their operations through improved medical credential management solutions.
What Is Credentialing (And Why It Matters)?
Credentialing is the process of verifying a provider’s qualifications so they can be enrolled with insurance plans and approved to bill in-network for their services. This typically includes:
- Verifying licensure, degrees, and certifications
- Submitting completed CAQH profiles or payer-specific forms
- Enrolling with Medicaid, commercial payers, and Managed Care Organizations (MCOs)
- Obtaining authorizations and contract approvals
Credentialing vs. Contracting
While credentialing verifies a provider’s qualifications, contracting is the next step where the provider signs an agreement with the payer and becomes officially listed as in-network. Credentialing doesn’t guarantee payment; contracting is what finalizes the in-network relationship and enables negotiated rates. Both are required before in-network claims can be submitted.
Delays can occur at either stage, but many ABA providers experience the longest lags between credentialing approval and final contract execution (the point at which they can begin billing in-network).
Is Credentialing A Legal Requirement for Billing?
Credentialing isn’t legally required for all billing scenarios, but it is necessary for in-network reimbursement or when billing Medicaid, Medicare, and most other government-funded programs. Out-of-network (OON) providers, or those who accept private-pay clients, can still legally bill without being credentialed, but they must disclose their OON status and follow payer-specific rules.
When a provider is credentialed and contracted, they are officially recognized by the payer. So, the payer lists them as an in-network provider, pays them at negotiated rates, and their clients can benefit from reduced cost-sharing through in-network co-pays or coinsurance. Without credentialing, providers can still deliver care and submit OON claims or collect private-pay fees, but those claims are reimbursed at lower rates (if at all), patients may face higher balances, and some plans simply will not cover ABA services from OON providers at all. So, while credentialing is not a legal prerequisite to bill, it is a financial necessity to capture in-network revenue, maximize reimbursement, and minimize out-of-pocket costs for patients.
Until credentialing and contracting are complete, most payers will not reimburse in-network claims, regardless of clinical need or staffing availability. That said, some payers do allow retroactive billing if the application was submitted before services began and all criteria are met. But policies vary widely, and providers should confirm eligibility with each payer before initiating services.
In short, without credentialing, clinics cannot submit in-network claims, even when qualified providers are ready to serve. And, while delays in the process may not be a new problem, they have become more frequent (and more disruptive) in 2025.
What Is Driving Medical Credentialing Delays in the ABA Industry?
Several overlapping factors are contributing to credentialing delays in 2025. From shifting Medicaid structures to inconsistencies across payers, ABA providers are navigating a medical credentialing environment that’s more fragmented — and more time-consuming — than ever. The most common causes include:
- Workforce and volume pressures: Timelines for credentialing medical providers are increasingly mismatched with hiring cycles. When clinics wait to initiate credentialing until after onboarding, there are BCBAs and RBTs who may remain on the payroll but inactive for months. In a field already managing staffing shortages, the delay between hire date and billable start date is a major constraint on growth.
- State-level Medicaid changes: States like Florida have recently transitioned behavioral health services under Medicaid to Managed Care Organizations (MCOs), many of which are underprepared for the resulting increase in credentialing volume.
- Inconsistent payer requirements: Each payer – sometimes each plan – requires its own credentialing packet, often with different standards for documentation, form submission, and timelines. A credentialing file that satisfies one MCO may be rejected by another due to a missing attestation or out-of-date license verification.
- Frequent regulation and portal changes: In 2025, payer portals are evolving rapidly, and requirements shift frequently. Keeping up with the latest expectations (let alone portal access credentials) is a full-time job in itself.
- Missing or incomplete documentation: Credentialing packets can include dozens of documents. One outdated license, unsigned attestation, or a lapsed liability certificate can kick a packet back to square one.
- Internal process gaps: Many ABA clinics are still managing credentialing through spreadsheets and manual tracking, increasing the risk of missed deadlines, documentation lapses, and duplicate submissions.
Impact of Delays on ABA Practices
The consequences of credentialing delays extend well beyond administrative and billing inconveniences. The operational and financial impacts are often felt clinic-wide:
- Increased stress and staff burnout: Repeated documentation requests, unclear timelines, and reactive workflows can all take a toll on morale.
- Delayed revenue: New hires can’t start delivering in-network care until they’re approved by key payers. So, a new BCBA may be sitting idle while waiting 90–120 days for payer approval, leading to significant lost revenue.
- Delayed authorizations: Some payers won’t begin authorizations until credentialing is complete, which extends the timeline for first service dates, though this varies by plan.
- Cash flow volatility: Smaller practices that rely on predictable reimbursement timelines face serious risk when credentialing approvals drag past budgeted expectations.
- Slowed hiring and growth: Clinics can’t onboard new staff or open new locations without credentialed providers in-network.
- Compromised patient care: Due to the delays in credentialing medicalprofessionals, families are waiting longer for care, especially in underserved communities where provider shortages are already acute.
How to Reduce Risk and Accelerate Timelines
Credentialing won’t speed up on its own. However, structured internal processes and the right operational partnerships can significantly reduce cycle times and error rates.
Start the Credentialing Process at Offer Acceptance
Waiting until a provider starts onboarding is too late. Credentialing should begin as soon as the offer is accepted. Create a credentialing intake checklist that includes licensure verification, NPI registration, insurance attestations, and CAQH updates — especially for new BCBAs and RBTs seeking to validate their ABA therapist credentials.
Maintain a Centralized Credentialing File
A centralized approach is one of the most effective medical credentialing services clinics can implement internally. Incomplete or inconsistent documentation is one of the common types of rejections in medical billing, many of which can be prevented with tighter credentialing workflows.
Track all credentialing-related documents in one secure system. Include expiration dates, license copies, malpractice certificates, and payer-specific application records. This file should be accessible to both your credentialing lead and your billing team to reduce duplicate outreach and delays.
Use Workflow Technology or Partner With a Credentialing Vendor
Credentialing platforms or verification services can handle payer-specific submissions and track application status across multiple insurers. These tools flag missing items, automate reminders, and reduce administrative burden. Clinics that outsource to medical billing and credentialing servicesoften report faster turnaround and fewer rejections, especially when working across multiple states or payers.
Monitor Credentialing Progress Weekly
Build credentialing check-ins into your operational calendar. Track where each application stands, which payers are awaiting information, and what documentation may need renewal. Monitoring these workflows — alongside key metrics for behavioral health billing — helps uncover bottlenecks and avoid revenue delays.
Align Credentialing and Authorization Management
Credentialing delays often cascade into authorization problems. Make sure your credentialing and billing teams coordinate timelines so that re-authorizations, initial authorizations, and eligibility checks can proceed the moment credentialing clears. Otherwise, you risk additional weeks of delay.
Looking Ahead
Credentialing in 2025 is a critical financial lever for ABA clinics. Beyond administrative burdens, delays in ABA credentials approval affect how ABA clinics grow, staff, and serve families who rely on their services. When credentialing is handled proactively and systematically, it can support faster onboarding, cleaner claims, and fewer denials. But, when delayed, it can create barriers at every step of the care and billing process.
This is why it is critical for ABA providers to treat credentialing as a strategic priority and not an afterthought. This proactive approach ensures they are better positioned to grow, retain talent, and deliver uninterrupted care.
Whether you manage credentialing in-house or through a trusted partner, success depends on strong internal systems and payer-specific insight. For providers considering outsourcing, understanding what to look for when choosing a medical billing company can make all the difference.
At Your Missing Piece, we understand how credentialing fits into the broader revenue cycle. We’ve supported ABA providers through every stage of payer enrollment, insurance change, and compliance shift because this work is about more than billing; it’s about helping your team stay focused on care.
Whether your clinic is preparing to onboard new staff, expanding into managed Medicaid, or simply trying to keep up with credentialing tasks across multiple payers, our team is here to help. Our experienced team offers medical billing services built specifically for ABA clinics, including credentialing support, payer-specific expertise, and workflows built around ABA. This expertise ensures we can help providers reduce delays and move forward with confidence.
If credentialing is holding your team back, let’s talk. We’ll help you put the right systems in place so that your providers can start sooner, your claims can move faster, and your practice can stay focused on patient care.