Association for Behavior Analysis International

The emergence of insurance funded Applied Behavior Analysis (ABA) benefits has introduced new requirements and complexity for providers of ABA services. Board Certified Behavior Analysts (BCBAs) are finding themselves in a new contractual relationship with health care plans without prior experience with utilization management and submission of claims. Managed care plans apply traditional insurance principles including medical necessity to the authorization of autism services to ensure appropriate treatment is being provided. They also demand knowledge of insurance terminology, billing practices and information sharing that may be outside the realm of a BCBA practitioners historical practice. The panelists will address the barriers that can arise between a managed care plan and ABA providers and focus on steps for facilitating the development of a collaborative relationship between provider and health plan. The panel will include professionals from managed care organizations that will discuss the importance of using data to inform and direct treatment progress, keys to obtaining authorization for treatment and critical information that is consistently reviewed by care managers. Other panelists will be ABA service providers who will share their perspective as to lessons learned and effective strategies used in their work with managed care organizations.