As the prevalence of autism spectrum disorder diagnoses has increased, so has the demand for applied behavior analysis services funded through insurance and managed care systems. This growth has brought behavior analysts into regular contact with managed care processes that were originally designed for medical and mental health services and may not be well-suited to the unique characteristics of ABA treatment.
Provider: CEUniverse
Take This Course →Including ethics, supervision, and topics like this one. New live CEU every Wednesday.
Join Free →Read the following article and pass an 8-question quiz on it: Papatola, K. J., & Lustig, S. L. (2016). Navigating a managed care peer review: Guidance for clinicians using applied behavior analysis in the treatment of children on the autism spectrum.Behavior Analysis in Practice, 9, 135-145. To earn credit, you will be required to read the article and pass an 8-question quiz about it. You can retake the quiz as many times as needed, but you will not receive exactly the same questions each time. As autism rates increase, providers of applied behavioral analysis (ABA) services are more frequently engaging with managed care companies to discuss the medical necessity of treatment. In an effort to maximize the efficiency and effectiveness of these reviews, we draw upon our experience as peer reviewers for a managed care company to guide ABA providers in discussions with managed care on behalf of their patients. In this article, we first provide an overview of the managed care peer review process. We then discuss the elements of medical necessity that managed care companies ask about during the review process. Finally, we review specific strategies that ABA providers can use during the process to optimize authorizations for payment for services. Throughout the paper, we provide sample dialogues between providers and peer reviewers based on our experience working for a managed care company along with specific recommendations that we hope will ensure a more collegial and effective peer review process for all involved. Only logged in customers who have purchased this product may leave a review.
| Certification Body | Credits | Type |
|---|---|---|
| BACB | 1.5 | Ethics |
Dig into the research behind this topic — plain-English summaries written for BCBAs.
280 research articles with practitioner takeaways
279 research articles with practitioner takeaways
258 research articles with practitioner takeaways
You earn CEUs from a dozen different places. Upload any certificate — from here, your employer, conferences, wherever — and always know exactly where you stand. Learning, Ethics, Supervision, all handled.
No credit card required. Cancel anytime.
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.