Services
Each service stands alone or bundles with the others. Most practices start with one and add the rest as the relationship grows.
Credentialing
We handle the entire credentialing lifecycle for your providers — new credentialing for first-time payer enrollments, recredentialing when the BACB or payer cycle requires it (every 3 years for most payers), and ongoing maintenance of every provider’s CAQH attestation.
What’s included:
- CAQH profile setup and quarterly attestation
- NPI registration (individual + group as needed)
- Commercial payer applications (Aetna, Cigna, UnitedHealthcare, Anthem, Humana, regional Blues)
- Medicaid and Medicaid MCO enrollment in every state where your practice operates
- TRICARE, FECA, and other federal program enrollment when applicable
- Follow-up cadence on pending applications (we don’t wait for the payer to update us — we call them)
- Document management and renewal alerts before credentials lapse
Best for: New BCBA owners credentialing for the first time, growing practices adding new providers, multi-state expansions, recredentialing cycles.
Billing & RCM
ABA billing is its own discipline. CPT codes 97151–97158, RBT supervision documentation, prior authorization workflows, Medicaid MCO variability state-by-state, modifier rules that differ per payer — generic medical billers fumble it. We don’t.
What’s included:
- Daily claim submission with ABA-specific coding (97151 assessment, 97153 protocol modification, 97155 direct intervention, 97156 family training, 97157 group, 97158 multifamily)
- Prior authorization tracking and renewal management
- Denial management and resubmission within payer-specific timely-filing windows
- Days-in-AR monitoring (industry benchmark: under 35 days for healthy ABA practices)
- Payer-specific clean-claim rate reporting
- Monthly reconciliation against your practice management system
- Year-end summary for tax and BHCOE/CASP accreditation reporting
Best for: Practices generating $500k+ in annual revenue, multi-payer practices, practices currently using a generalist medical biller, practices preparing for accreditation or audit.
Payer Contract Negotiation
If your payer rates haven’t been renegotiated in three or more years, you’re almost certainly leaving money on the table. We handle initial commercial contract negotiations, renegotiations after rate review periods, and Medicaid MCO contracting where state law permits negotiation.
What’s included:
- Market-rate benchmarking for your CPT mix and geography
- Initial contract negotiation with commercial payers
- Re-negotiation when rates haven’t moved in 2+ years
- Single-case agreement (SCA) negotiation for out-of-network situations
- Network adequacy advocacy in states with autism-mandate enforcement
- Contract review and red-flag identification (rate-floor language, audit clauses, termination provisions)
Best for: Established practices with 2+ years of payer relationships, practices entering new markets, practices that suspect they’re underpaid relative to peers.
Practice Startup
The hardest part of opening a new ABA practice isn’t clinical. It’s the 90-180 day window between deciding to open and getting credentialed enough to bill. We compress that window by parallel-tracking everything that can be parallel-tracked.
What’s included:
- Entity formation guidance (LLC, PLLC, S-Corp considerations for ABA)
- NPI and tax ID setup
- BACB practice registration
- Initial CAQH and payer enrollment (start day-1 of decision, not day-1 of doors-open)
- Billing infrastructure setup (clearinghouse, claim submission workflow, EOB processing)
- Operational consultation (RBT supervision ratios, documentation standards, audit preparation)
- BHCOE/CASP accreditation prep when relevant
Best for: BCBAs leaving an employed role to start their own practice, established practices expanding to a new state, anyone in the 6-month window before opening doors.
Multi-State Expansion
Multi-state operations multiply credentialing complexity. Every state has different Medicaid MCO requirements, different commercial payer footprints, different licensing requirements, and different timely-filing rules. We handle that complexity so you don’t have to staff for it.
What’s included:
- State-by-state licensing strategy
- Per-state payer mix analysis and prioritization
- Parallel-tracked credentialing across all target states
- State-specific Medicaid MCO enrollment
- Compliance with state-specific autism mandate variations
Best for: Practices currently in one state planning to expand to a second or third, regional groups consolidating multi-state operations.
Major payers we work with
We work with every major commercial and government payer that covers ABA therapy. A sample of those we credential and bill with regularly:
Aetna · Anthem Blue Cross Blue Shield (multi-state) · Cigna · UnitedHealthcare / Optum · Humana · Magellan Healthcare · TRICARE · State Medicaid (all 50 states) · Medicaid Managed Care Organizations (Centene, Anthem, Molina, AmeriHealth, regional MCOs)
Don’t see yours? We probably still work with them. Most ABA-covering payers are on our roster — ask in your consultation.
Common questions
How long does credentialing typically take?
Commercial payers run 60–120 days from application to network acceptance. Medicaid and Medicaid MCOs run longer — 90 days to six months depending on state, payer, and whether the BCBA already has a CAQH profile. We compress this where possible by parallel-tracking applications and following up weekly.
Do you work with our existing billing software?
Yes. We’re software-agnostic. Whether you use CentralReach, Rethink, Hi-Rasmus, ABA Matrix, or any other ABA-specific practice-management tool, we work with what you have.
What are your fees?
Fees depend on the scope of work. Credentialing is typically priced per provider per payer. RCM is typically a percentage of collections. Contract negotiation and practice startup are flat-fee or hourly. We give you a clear, written quote after the consultation — no surprise pricing.
Do you work with practices in [my state]?
Yes. We work with practices in every U.S. state, including all Medicaid MCOs where state law permits outside credentialing assistance.
What if my practice is already credentialed and just needs RCM?
We do standalone RCM. Many of our clients are established practices who came to us specifically because their previous biller wasn’t delivering. We assess your current claim aging, denial patterns, and AR — and tell you honestly what’s salvageable and what’s not.
Can you help with a payer audit?
Yes. Audit support — preparing documentation, responding to payer inquiries, advocating during the review — is part of what we do. The faster we’re brought in, the better the outcome typically is.
Do you offer single-case agreements (SCAs)?
Yes. SCA negotiation for out-of-network clients is a regular part of what we do, particularly for families in areas where in-network ABA capacity is limited.
Will I have a single point of contact, or a generic support inbox?
Single point of contact. Every client has a named specialist who owns their account. You’ll know who to call, who to email, and who’s accountable for the outcome.
Ready to talk?
Free 30-minute consultation. We’ll learn about your practice and tell you exactly what we’d handle.