Missing Piece Blog

Guide To Obtaining ABA Authorization

Securing ABA medical insurance authorization is a critical step for ABA providers utilizing both in-network and out-of-network insurance. Insurers mandate ABA therapy authorization as a prerequisite for reimbursing the services provided to patients. Although obtaining authorization is necessary, navigating the process is not always simple.

Missing Piece offers expert third-party insights and professional guidance on managing the authorization procedure correctly from the outset. Our assistance aims to reduce the likelihood of delays stemming from insurance issues while promoting an efficient and effective process.

Understanding the insurance authorization process

There are three steps to ABA health insurance authorization.

  1. Prior authorization: Prior authorization helps clarify the extent of ABA therapy coverage under a patient’s insurance plan. 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: An assessment must prove that the patient requires this type of care. An ABA treatment plan is developed for the patient, which includes the number of therapy hours they qualify for.
  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 a strong informational baseline to manage ABA authorizations effectively. Patients should be educated about insurance authorization and the type of care each needs. This starts with verifying benefits through prior authorization.

Additionally, providers should implement a streamlined system to facilitate efficient authorization processes. Given the potential for extensive communication exchanges and inquiries, effective protocols can significantly minimize the risks associated with incomplete data. Ensuring consistent cataloging of all patient information is also key to simplifying the authorization procedure. 

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 the entire duration of patient 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 ABA insurance authorization processes

Insurance authorization forms a significant part of most ABA practices. While laws now mandate this type of care for patients, insurers and patients are still required to prove 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. 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.