What is ABA credentialing?

ABA credentialing is the process of enrolling an ABA agency and its BCBAs with Medicaid, Medicaid managed care plans, and commercial insurers so the practice can bill them in network. It includes CAQH profiles, payer applications, contracts, and tracking renewals.

Do RBTs need to be credentialed with insurance?

It depends on the payer. Some payers enroll RBTs individually, while others require RBT services to be billed under the supervising BCBA. Ask each payer which model it uses before RBTs start sessions with that payer's members.

How do BCBAs get credentialed with insurance companies?

A BCBA needs an individual NPI, a complete and attested CAQH profile, and a state license where the state requires one. The BCBA, usually through their agency, then applies to the state Medicaid program, Medicaid managed care plans, and commercial payers, and each payer issues a contract and effective date if its panel is open.

What CPT codes do ABA providers bill?

ABA services are billed with Category I CPT codes 97151 through 97158, which took effect on January 1, 2019. Each payer's contract or fee schedule shows which codes each credential level may bill.

Do ABA services need prior authorization?

Many plans authorize ABA hours in advance. Authorization is separate from credentialing, so a practice needs both an active contract and an approved authorization before treatment starts.

ABA Credentialing for BCBAs and ABA Practices

ABA Credentialing for BCBAs and ABA Practices | Qualigenix