This comparison draws in part from “Navigating the Peer Review Process – Lessons Learned from Dating” by Alexandra Tomei, M.Ed., BCBA, LBA (TX), LSSWB (BehaviorLive), and extends it with peer-reviewed research from our library of 27,900+ ABA research articles. The decision framework, BACB ethics code references, and cross-links below are synthesized by Behaviorist Book Club.
View the original presentation →Behavior analysts who navigate the insurance peer review process can be broadly categorized by their approach: reactive or proactive. Reactive practitioners wait for peer review requests, prepare in the moment, and respond to authorization decisions after they are made. Proactive practitioners anticipate peer review requirements, prepare documentation and clinical narratives in advance, build relationships with reviewers over time, and design treatment plans with authorization criteria in mind from the outset. Alexandra Tomei's relationship-based framework aligns with the proactive approach, emphasizing preparation, communication, and ongoing relationship management rather than crisis response. This comparison examines how each approach affects peer review outcomes and, ultimately, client access to services.
| Factor | Evidence-Based Approach | Traditional Approach |
|---|---|---|
| Timing of preparation | Reactive: Begins preparing when notified of a peer review; documentation may be incomplete or disorganized at the time of review | Proactive: Maintains review-ready documentation throughout the authorization period; treatment plans written with peer review criteria in mind from the start |
| Reviewer relationship | Reactive: Each peer review is treated as an isolated event; no relationship continuity with reviewers across authorization periods | Proactive: Builds professional rapport with assigned reviewers over time; proactive communication between formal review periods |
| Communication during review | Reactive: May become defensive or disorganized during the call; relies on the strength of the treatment plan to carry the conversation | Proactive: Prepared, concise, and collaborative; addresses anticipated concerns proactively and frames the conversation around clinical outcomes |
| Response to adverse decisions | Reactive: Scrambles to prepare appeal documentation after a denial; may miss appeal deadlines or submit incomplete appeals | Proactive: Has appeal strategies and documentation prepared in advance; responds quickly and comprehensively to adverse decisions |
| Impact on treatment planning | Reactive: Treatment plans are designed primarily for clinical purposes; medical necessity language and authorization rationale may be afterthoughts | Proactive: Treatment plans integrate clinical excellence with clear medical necessity documentation; goals are framed in terms that both clinicians and reviewers can evaluate |
| Stress and burnout | Reactive: Peer reviews experienced as high-stress events that disrupt clinical workflow and generate anxiety | Proactive: Peer reviews experienced as routine professional conversations that are managed within normal workflow |
The ABA Clubhouse has 60+ on-demand CEUs including ethics, supervision, and clinical topics like this one. Plus a new live CEU every Wednesday.
Use this framework when approaching navigating the peer review process – lessons learned from dating in your practice:
Does the data support a need for intervention? Is there a meaningful impact on the individual's quality of life, safety, or access to reinforcement?
YES → Proceed to assessment NO → Document reasoning, monitor
A functional assessment should guide intervention selection. Avoid defaulting to standard protocols without individual analysis. Consider environmental variables, setting events, and private events.
YES → Select evidence-based approach matched to function NO → Complete assessment first
Goals should be co-developed. Assent and informed consent are ethical requirements. The individual's preferences and values matter in selecting both goals and methods.
YES → Proceed with collaborative plan NO → Engage in shared decision-making
This course covers the clinical and ethical dimensions in detail with structured learning objectives and CEU credit.
Navigating the Peer Review Process – Lessons Learned from Dating — Alexandra Tomei · 1 BACB Ethics CEUs · $19.99
Take This Course →We extended this decision guide with research from our library — dig into the peer-reviewed studies behind each approach, in plain-English summaries written for BCBAs.
280 research articles with practitioner takeaways
279 research articles with practitioner takeaways
258 research articles with practitioner takeaways
1 BACB Ethics CEUs · $19.99 · BehaviorLive
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All behavior-analytic intervention is individualized. The information on this page is for educational purposes and does not constitute clinical advice. Treatment decisions should be informed by the best available published research, individualized assessment, and obtained with the informed consent of the client or their legal guardian. Behavior analysts are responsible for practicing within the boundaries of their competence and adhering to the BACB Ethics Code for Behavior Analysts.