ABA Therapy Billing—Negotiating an In-Network Single Case Agreement (SCA) for Out-Of-Network Providers

ABA Therapy Single Case Agreement

ABA Therapy Billing—Negotiating an In-Network Single Case Agreement (SCA) for Out-Of-Network Providers

Tips for ABA Therapy providers and intake or authorization coordinators to help gain Single Case Agreements for In-Network payment as an Out-Of-Network provider.

Even though your agency may be Out-Of-Network (OON) with a particular insurance company, you may still have the option of negotiating a Single Case Agreement (SCA) to be recognized as an In-Network (INN) provider. For ABA services, the criteria will be that there are no INN providers available for the same services in your area. For every OON plan for which you are working to obtain an Authorization, ALWAYS request an SCA—it never hurts to ask, right? Follow these steps and you may be granted an SCA for the best benefit payment.

Obtaining a Single Case Agreement

  • Make the SCA request at the same time you are asking for the Initial Assessment Authorization.
  • The insurance plan rep will search for providers in your area and report back to you.
  • Be prepared to negotiate fees based on your fee schedule.
  • Some plans will allow a “pay at highest in network rate”—this is defined as the client being able to access in network benefits but does not allow you to negotiate your own rates, and you will not be able to balance bill clients.
  • Some plans require you to be currently working through the INN process.
  • Be aware that some insurance companies require the SCA be in the Rendering Provider’s name which may impact information on the 1500 claim form.
  • You may need to help parents phrase how to request a letter from an INN agency if your program meets a unique need that other INNs cannot fulfill (e.g., Our INN agency does not offer 35 hours a week in a clinic with 10 weeks of interaction with typical peers in a preschool setting, but [name of your agency] does.).
  • If granted an SCA, watch for the date range that the SCA is applied to (usually matches up to Auth) and schedule in the request for a renewed SCA the same time as the new Auth.
  • And lastly, always ask if the SCA changes where you mail your claims for payment.
  • Note: SCAs are sometimes referred to as gap agreements.

As long as you meet the requirements, you should be able to obtain the Single Case Agreement for payment as an In-Network provider. As with each process, preparation is the necessary key. Know what you are asking for, know how to ask for it, and ask for it with confidence. Leave a comment and let us know what you think of these tips and if there is anything else you would like to know further about SCAs.

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