EXCLUSIVELY FOR AUTISM TREATMENT PROVIDERS
The demand that insurance companies cover autism treatments is sweeping the nation. To date, 38 states plus the District of Columbia and the U.S. Virgin Islands have enacted autism insurance reform laws requiring that health insurance companies cover the diagnosis and treatment of autism spectrum disorders, and more states are on the way.
Regardless of whether a law is already on the books in your state, is in the pipeline, or is on the horizon, you should be thinking seriously about the dramatic operational changes you’ll need to make to ensure that you, your practice and practitioners can (and do) get credentialed and contracted with the leading insurance carriers in your area.
What does autism insurance reform mean for you, the treatment provider?
It means that starting now, or in the very near future, you will need to be positioned to bill insurance companies directly for your clients’ treatments. The process of getting established as an in-network provider involves a series of steps intended to ensure that you, your colleagues and your practice meet the necessary educational, professional, operational and regulatory standards the insurance companies require.
What do you need to do to prepare?
Each provider is different so there is no one-size-fits-all recipe. The contracting and credentialing process is essentially an interview in which you, the provider, are expected to demonstrate that you are able to do the job the insurance company is going to pay you to do, and that you will do it in the way they want you to. In preparing for the interview it’s essential that you know what the insurance companies are looking for in their providers and in their agencies.
What can ATPIAN do to help?
ATPIAN is the only consulting firm specializing exclusively in the needs of autism treatment providers and their unique challenges in the insurance credentialing, audit and contracting process. We partner with you and advocate for you to achieve your insurance credentialing and contracting goals and are here to help you at every step of the way. We will evaluate where you stand relative to the known requirements and help you fix any deficiencies; assist you with the creation of a complete set of documents, policies, procedures and forms that meet with insurance company standards and requirements; help you negotiate rates; submit your applications and related documents; help you prepare for your audit, and follow up regularly both with you and with the insurance companies to ensure that everything is on track.
We appreciate that insurance credentialing and contracting are not your specialty, not what you anticipated dealing with when you set up your practice, and most definitely not your first choice of activities. We know that your specialty is providing your clients and their families with the autism treatments that will enable them to maximize their potential, to live happy, productive and meaningful lives. That's what you studied, that's where your passions reside and that's where your skills are best utilized.