ABA Credentialing: Easy Guide to Getting Approved by Insurance

If you just started your Applied Behavior Analysis (ABA) clinic, credentialing is the first step to getting paid by insurance payors. Without ABA credentialing, you can’t submit claims or get coverage for your services.

Documents you'll need for ABA credentialing

Insurance payors require lots of paperwork that proves you’re qualified to offer ABA services. You’ll need materials for both individual providers and your organization. Here’s a list of the documents you’ll need:

Individual provider documents:

• Professional resume, detailed and up-to-date 
• Copies of licenses, including Board Certified Behavior Analyst (BCBA) certification and any other relevant state or professional licenses
• Proof of insurance: Malpractice and liability insurance certificates
• Tax Identification Number (TIN) and National Provider Identifier (NPI)
• Background check results
• Continuing education documentation
• Professional references

Organization documents:

• Business license
• Tax Employer Identification Number (EIN)
• Proof of liability insurance
• Corporate structure documents, like articles of incorporation

You will need all these documents to create a Council for Affordable Quality Healthcare (CAQH) profile.

What is a CAQH profile? 

A CAQH profile is a centralized online database where healthcare providers store their credentials. Insurance companies use this system to verify your qualifications, so you don’t have to submit the same forms repeatedly.

Most major insurance providers use CAQH to simplify the credentialing process. That means you should make sure your CAQH profile is accurate, complete, and regularly updated. Small errors (expired license, wrong NPI, missing signature) can send your entire application back to the beginning; therefore, double-check everything.

The ABA credentialing process: step by step

Credentialing is the first step to getting reimbursed for ABA services. Follow these steps to avoid delays and make sure your clinic is ready to bill insurance:

Step 1: Apply for your NPI 

Start by registering for an NPI through the National Plan and Provider Enumeration System (NPPES portal). This unique 10-digit number identifies you as a healthcare provider.

This requires completing an online application where you will need to input: 

• Your Social Security Number and/or EIN
• BCBA or Board Certified Assistant Behavior Analyst (BCaBA) certificate number
• State license number (if applicable)
• Taxonomy code for a behavior analyst (Taxonomy code for behavior analysts: 103K00000X)

Step 2: Create your CAQH profile 

Upload all your credentials, education, licenses, and work history to the CAQH database. Insurance companies pull from this database to verify your qualifications for claims approval, so accuracy is essential.

Step 3: Identify target payors 

Start with major commercial insurers, like Aetna, Cigna, and Blue Cross Blue Shield. Then apply to Medicaid if you plan to serve publicly funded clients. To provide ABA therapy to Medicaid recipients, you must be credentialed with Medicaid. 

However, credentialing with Medicaid does not automatically include Managed Care Organizations (MCO) plans. You must be individually credentialed with each MCO.

Step 4: Submit credentialing applications 

Each payor has its own application process that needs to be completed.

Complete all forms thoroughly and double-check every field. Any inaccuracies or omissions can delay the credentialing process.

Step 5: Wait and follow up 

Credentialing takes time. Typically, the process lasts from 90 to 120 days. Timelines for group and individual applications vary and depend on each payor’s requirements. Contact your insurance payors monthly to check the status.

Step 6: Receive approval and sign the contract 

Once your ABA insurance credentialing application is approved, you'll receive a contract from the insurance payor. Review this contract carefully, preferably with legal support. Pay attention to reimbursement rates, services covered, and other obligations.

Why credentialing takes so long (and how to speed it up)

Credentialing delays can stall your clinic’s revenue cycle for months. On average, the process takes 90 to 120 days, though timelines vary by payor and application type. Common reasons for delays are: 

1. Missing or incomplete documentation: Even one outdated license, unsigned attestation, or lapsed liability certificate can delay the process.
2. Manual credentialing tracking: The use of spreadsheets and manual tracking can increase the risk of missed deadlines, documentation lapses, and duplicate submissions.
3. Payor portal changes: Insurance payor requirements and portals can change over time, so using outdated information can cause delays.

How to speed up the ABA credentialing process:

• Submit complete, accurate documents the first time.
• Use credentialing software to track deadlines.
• Follow up monthly with each insurance payor.
• Consider hiring a credentialing service for complex or group applications.

Credentialing checklist for ABA practices

Before submitting your credentialing application, make sure every item below is complete and accurate, as even small errors can delay approval by weeks:

• NPI obtained and verified
• CAQH profile created and accurate
• All licenses current and scanned
• BCBA/BCaBA certificate uploaded
• Proof of liability insurance current
• Background check completed
• Resume/CV updated
• Tax ID and W-9 form ready
• All forms filled out completely (no blanks)
• Application reviewed by second person (catch errors)
• payor-specific requirements identified and met
• Submission date documented
• Follow-up calendar set (monthly check-ins with payors)

Common credentialing mistakes (and how to avoid them)

Preventing credentialing mistakes is more cost-effective than dealing with the delays they cause.

If you keep experiencing credentialing delays, you may be making one of these mistakes:

Mistake 1: Incomplete or outdated documentation 

You will be months behind if insurance payors reject your application. That’s why it’s easier to use a document checklist that you should update quarterly.

Mistake 2: Forgetting contracting 

Credentialing gets you approved. Contracting is what allows you to bill. After credentialing, you must sign a contract with each payor to finalize your in-network status. 

Track credentialing and contracting as separate steps. Don’t assume one includes the other. 

Mistake 3: Missing re-credentialing deadlines 

If you miss the re-credentialing deadline, you could lose in-network status without realizing it. Therefore, set reminders at least 6 months before re-credentialing dates to allow time for paperwork and follow-up.

Mistake 4: Not following up with payors 

Credentialing applications can sit in review queues without regular follow-up. Call or email each insurance payor monthly during the 90- to 120-day processing window to check the status and keep things moving.

Mistake 5: Hiring providers without CAQH profiles 

If new hires don’t have a CAQH profile ready, onboarding delays are inevitable. Every new provider must start credentialing from scratch. It is therefore good practice to require CAQH setup before the hire start date.

Special rules for Medicaid credentialing

Medicaid credentialing is state-specific, which makes it a bit more complex than commercial insurance.

Each state contracts with multiple MCOs to administer Medicaid benefits. That means you’ll need to credential with both the state and each MCO individually. 

Things to note for Medicaid:

1. You must be credentialed with your state Medicaid program first.
2. Apply to each Medicaid MCO separately.
3. Each MCO has different credentialing forms and timelines.

You must submit separate applications for each MCO. This multiplies the work but opens access to Medicaid clients.

Make ABA credentialing easier with Passage Health

Most ABA practices track credentialing with spreadsheets and email, which means important deadlines get missed and providers can't bill when re-credentialing expires.

Practice management software, like Passage Health, helps you keep all provider information in one place.

Passage Health's practice management platform enables you to store and view documents for team members on the web and mobile app.

You can store documents such as licenses, certifications, NPI numbers, and payor approval statuses in a single location where your entire team can view them.

You can also track team member certifications and receive notifications when certificates expire, so you never miss a re-credentialing deadline.

While Passage Health doesn't handle the actual credentialing for you, it prevents mix-ups and lost documents that can delay the ABA credentialing approval process.

Book a demo to see how Passage Health manages credentialing tracking alongside your clinical and billing workflows.

Frequently asked questions

How long does ABA credentialing actually take? 

The ABA credentialing process typically takes 90 to 120 days. Some payors process faster, but Medicaid and Medicare programs often take longer. Plan for 4 to 6 months to be safe.

Do I need credentialing if I only take self-pay clients? 

No, you don’t need credentialing if you only take self-pay clients. Credentialing is only needed if you plan to bill for any insurance (commercial, Medicaid, or Medicare). Most ABA practices need credentialing for revenue.

Can I bill clients while waiting for credentialing approval? 

You can bill clients directly as out-of-network; however, in-network billing requires approval and a signed contract with the payor.

What happens if my credentialing application is denied? 

If your credentialing application is denied, ask the payor for the reason. Common reasons for credentialing denial include: incomplete documentation, credential issues, or practice location problems. Once you have identified the reason, you can fix and reapply.

Do all my providers need credentialing? 

Yes, all BCBAs and BCaBAs need insurance credentialing. 

RBT requirements vary by payor, some insurance companies require RBTs to be separately credentialed, while others allow them to work under the supervising BCBA's credentials.

Check with each payor to confirm their specific RBT credentialing requirements.

What is ABA credentialing? 

ABA credentialing is the process insurance companies use to verify that you and your providers are qualified to deliver ABA therapy and can get paid for it. Without credentialing, insurance won't reimburse your claims, even if you deliver great care.

Credentialing verifies your qualifications as a BCBA, confirming you have the necessary education, training, certifications, and licenses to provide ABA therapy. 

What is the difference between contracting and credentialing?

Credentialing is the process that insurance payors use to verify a provider's credentials and to make sure that they meet the standards required by that insurance payor to render services.

Contracting is the process of officially getting into the network of insurance payors. You and the insurance payor will sign a contract that outlines the conditions or terms of the agreement, as well as the obligations of each party.

You need both credentialing and contracting to bill insurance and get paid. Credentialing happens first, then contracting.

References

CentralReach. (n.d.). ABA credentialing for providers starting an ABA practice. https://centralreach.com/blog/aba-credentialing-for-providers-starting-an-aba-practice/

Centers for Medicare & Medicaid Services. (n.d.). Medicaid program. https://www.medicaid.gov/

Centers for Medicare & Medicaid Services. (n.d.). Medicaid managed care organizations (MCOs). https://www.medicaid.gov/medicaid/managed-care

Centers for Medicare & Medicaid Services. (n.d.). National provider identifier (NPI) registry. https://npiregistry.cms.hhs.gov/

Centers for Medicare & Medicaid Services. (2016). Frequently asked questions: Medicaid provider enrollment requirements [PDF]. https://www.medicaid.gov/files/document/mpe-faqs082616.pdf

Council for Affordable Quality Healthcare. (n.d.). For providers. https://www.caqh.org/

Dubuque, E. M., Yingling, M. E., & Allday, R. A. (2020). The misclassification of behavior analysts: How national provider identifiers (NPIs) fail to adequately capture the scope of the field. Behavior Analysis in Practice, 14(1), 214–229. https://doi.org/10.1007/s40617-020-00451-w

National Credentialing. (n.d.). How long does credentialing take? https://nationalcredentialing.com/how-long-does-credentialing-take/

Passage Health. (n.d.). Help the autism community and your team thrive. passagehealth.com