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Obtaining ABA Authorization | Your Missing Piece

Guide To Obtaining ABA Authorization

Whether you are an ABA provider that is in-network with an insurer or out-of-network, authorization for therapy is essential. Insurance companies require ABA authorization before they will reimburse providers for the therapy they deliver to the patient. Authorization may be a requirement, but it is not always a simple, straightforward process.

Missing Piece provides third-party insight and professional industry knowledge on the authorization process, ensuring it is done properly from the start. We can help minimize the risk of delay related to insurance coverage. We can also help ensure the process is efficient and productive.

Understanding the Insurance Authorization Process

There are three steps to authorization.

  1. Prior Authorization: Prior authorization allows for a better understanding of the care a patient’s insurance plan will cover for ABA therapy. It also ensures the patient meets the medical-necessity requirements to receive that care. This often involves meeting a specific age requirement and obtaining a formal diagnosis.

  2. Authorization Process: In this step, an assessment must show that the patient needs this type of care, and a treatment plan is developed for her or him — including the number of hours for which she or he qualifies.

  3. Ongoing Services Authorization: A treatment plan and ASD diagnostic report are used to support the need for ongoing care for the patient. Treatment is typically authorized for a certain period — such as six months at a time — before a re-evaluation is needed.

How to Ensure Efficient Authorization

Providers need to have a strong informational baseline in place to educate their patients about insurance authorization and the type of care each patient needs. This starts with the verification of benefits through prior authorization.

It’s also important for providers to have a system in place that promotes easy authorization. Because there can be a lot of back-and-forth and questions, protocols should be in place to minimize any missing information. It’s also important to ensure all your patients’ information is catalogued consistently.

The authorization process is not a one-time investment. There are usually numerous assessments — especially right after authorization is provided — and ongoing authorizations are needed for as long as your patients continue care. More so, all these steps require careful tracking to ensure that they can be verified with the insurer as needed.

At the same time, your patients’ needs must be met efficiently. This helps ensure they receive effective, meaningful ABA therapy. For providers, it is critical to ensure that the best service is provided to their patients while streamlining the authorization process.

Improving Insurance Authorization Processes

Insurance authorization is a big part of most ABA practices. While laws now mandate this type of care for patients, insurers and patients still must show that a patient needs this care before receiving it. This can be complicated since providers may not be sure what level of care or treatment a patient needs prior to completing assessments.

As complicated as the process is, it is necessary. Missing Piece can help. As an outsourced authorization team, Missing Piece provides assistance navigating these tasks and ensuring the best outcome for providers and patients.

To learn more about the services we offer, contact us today.