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.


47th Annual Convention; Online; 2021

All times listed are Eastern time (GMT-4 at the time of the convention in May).

Event Details

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Panel #100
CE Offered: BACB
Building a Framework of Resources, Training, and Data Analysis Regarding Prior Authorization and Claims Denials for Health-Insurance-Funded Applied Behavior Analysis Services: Preliminary Results
Saturday, May 29, 2021
3:00 PM–3:50 PM
Area: AUT/OBM; Domain: Service Delivery
CE Instructor: Hannah Stauffer, M.A.
Chair: Hannah Stauffer (Kadiant)
DIANA M. DAVIS WILSON (Aspen Behavioral Consulting; Arizona Association for Behavior Analysis)
TORI BEJAR (Kadiant)

As of 2019, all 50 states in the continental United States have taken action to require state-regulated health plans to provide meaningful coverage for the treatment of autism. Although the need for insurance-funded applied behavior analysis services is exponentially growing, Board Certified Behavior Analysts and related support teams often have little to no formal training in working with these payers. Simultaneously, insurance companies are establishing increasingly complex internal review processes that may or may not be informed by members of our field, resulting in increased opportunities for denials based on medical necessity. The current panel serves to provide both the conceptualization and implementation of an internal framework that organizations could adopt to assist with clinicians and administrative support teams in decreasing the likelihood of preauthorization and claims denials, as well as to equip clinicians to effectively advocate for appropriate levels of care when services are denied. The panel will also discuss how internal metadata can be developed and maintained cross-functionally to pinpoint areas for needed training, updating resources, or engaging in dialogues with payers.

Instruction Level: Intermediate
Target Audience:

Introductory understanding of working with health plans. Awareness of prior authorization processes. Working knowledge of CPT codes.

Learning Objectives: At the conclusion of the presentation, participants will be able to: (1) identify contributing factors leading to prior authorization insurance denials; (2) analyze and prioritize antecedent strategies to decrease the likelihood of insurance denials, and (3) describe a system to develop on internal metadata system to analyze denials trends.
Keyword(s): Appeal, CPT, denials, insurance



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Modifed by Eddie Soh