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Association for Behavior Analysis International

The Association for Behavior Analysis International® (ABAI) is a nonprofit membership organization with the mission to contribute to the well-being of society by developing, enhancing, and supporting the growth and vitality of the science of behavior analysis through research, education, and practice.

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44th Annual Convention; San Diego, CA; 2018

Workshop Details

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Workshop #W37
CE Offered: BACB
A Comprehensive Look at Authorizations, Appeals,and Peer Reviews
Friday, May 25, 2018
8:00 AM–11:00 AM
Room to be Announced
Area: PRA; Domain: Service Delivery
CE Instructor: Ashley Williams, M.S.
JULIE KORNACK (Center for Autism and Related Disorders ), ASHLEY WILLIAMS (ABACS), THEA H. DAVIS (Autism Bridges), BRANDON HERSCOVITCH (ABACS, LLC), CATHY J. BOOTH (Autism Bridges)
Description: In this workshop, attendees will be guided through the authorization and appeals processes. Attendees will be exposed to state and federal laws that all clinicians should be aware of that guide and support clinical recommendations, continuity of services, and access to care for the populations served. This workshop provides an emphasis on creating internal processes and procedures to lend support to clinician's recommendations for service delivery based on medical necessity. Attendees will be provided with guidance on submitting authorizations and appeals, preparing for and holding a utilization/peer reviews, holding external reviews, and contacting relevant representatives when violations occur. Common reasons for denial of services and recommendations for generating support for these services will be a focus of this workshop (i.e., insurance-funded services in schools, role of parent training, location of services, services that are "educational" in nature).
Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) describe the peer review and appeals process for insurance-funded ABA services; (2) identify the materials needed in preparing for a peer-review; (3) list at least one state or federal regulation that governs insurance-funded ABA services in New England.
Activities: Workshop activities will include small group discussions, large group discussions, scenario-based exercises, and oral/written practice opportunities.
Audience: The target audience for this workshop is behavior analysts who provide insurance-funded services (Master's/PhD-level).
Content Area: Practice
Instruction Level: Advanced
Keyword(s): authorizations, insurance appeals, insurance services, peer review

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