Frequently Asked Questions

Credentialing is the process that insurance companies use to verify that a provider meets their standards to deliver and bill for services. For ABA practices, completing this process with each payer is a prerequisite to getting paid. Delays or errors in credentialing translate directly into delayed revenue and claims denials, which is why getting it right matters.

It varies significantly by payer. Some commercial plans process applications in 60–90 days; others, particularly Medicaid managed care organizations, can take four to six months or longer. Certain payers also have credentialing windows or periodic enrollment freezes that affect timing. Part of what Modulo Health does is manage expectations, track application status proactively, and push for faster resolution when delays arise.

Most commercial payers credential BCBAs as individual providers, while RBTs typically bill under the agency or supervising BCBA rather than being individually paneled. Medicaid programs handle this differently by state. Modulo Health maps out the right credentialing structure for your payer mix and ensures each clinician is set up correctly so your claims go through without issue.

Panel closures are common in ABA, but they aren't always permanent (and they aren't always enforced the way payers describe them). Modulo Health verifies panel status directly, identifies whether exceptions or hardship pathways exist, and pursues single case agreements (SCAs) so you can see clients and get reimbursed while the broader credentialing process moves forward.

Credentialing is the payer's verification of your qualifications. Contracting is the legal and financial agreement that defines how you'll be paid, including: your fee schedule, billing requirements, and the terms under which the payer can change or terminate the arrangement. Both are required to participate in a payer's network, but they're separate processes and need separate attention.

In many cases, yes. ABA-specific CPT codes (97151–97158, T-codes, and H-codes) are frequently underpaid relative to the actual cost of services, and initial rate offers from payers are not always final. Modulo Health reviews your proposed fee schedule against market standards, identifies where negotiation is viable, and supports the conversation with data. Not every payer will budge, but it's always worth asking before signing.

Beyond the fee schedule, key areas to review include timely filing windows, authorization requirements, audit and recoupment provisions, credentialing maintenance obligations, and termination clauses. Some contracts contain terms that give payers broad recoupment rights or allow fee schedule changes with minimal notice. Modulo Health reviews contracts with these issues in mind before you commit.

Modulo Health provides billing compliance consulting, which means reviewing your current billing practices, identifying coding errors or documentation gaps that create audit risk, and building processes that hold up to payer scrutiny. The goal is equipping your team to bill correctly and compliantly, and supporting you when problems arise. Additionally, Modulo Health offers direct end-to-end billing services if you have not yet found a billing agency for your needs.

Start with denial categorization. Not all denials have the same root cause: credentialing mismatches, authorization issues, coding errors, and timely filing failures each require a different fix. Modulo Health analyzes your denial patterns to identify where the real problems are, rather than chasing individual claims. From there, we address the issues behind your denial volume.

The main risk areas for ABA practices are: unsupported units (billing time that isn't backed by session notes), upcoding or incorrect use of supervision codes, billing before authorization is in place, and failing to document BCBA oversight of RBT-delivered services. If you haven't had a compliance review recently, it's worth doing so proactively; payers can and do conduct retrospective audits, sometimes years after the fact.

Yes. Modulo Health works with ABA practices nationally. Payer requirements, Medicaid structures, and credentialing pathways vary significantly by state, so multi-state practices need someone who understands that variation rather than assuming one approach applies everywhere.

Modulo Health is a boutique consultancy, which means you're working directly with Christopher and not getting handed off to a junior team member after the initial call. Engagements are scoped based on your specific needs, whether that's a one-time project, ongoing credentialing and billing support, or a compliance review. Everything is tailored directly to you rather than packaged.

The best first step is a brief discovery call or email to talk through where your practice is and what you need; no question is too small and no task is too large. From there, Modulo Health can scope an engagement that's actually useful rather than overselling services you don't actually need. Reach out here to schedule.