Single Case Agreement Vs Prior Authorization
Some insurers require that the case-by-case agreement be that of the rendering provider, which must be submitted on claim form 1500. There are many therapeutic processes such as ABA therapy, where continuity of care is essential to achieve treatment goals. When a customer switches to a new insurance provider, it is important to maintain continuity of supply or establish a transition plan to a new network provider. In many of these scenarios, it is often necessary to negotiate an agreement on a case-by-case basis. A case-by-case agreement is designed to meet the patient`s essential treatment or therapy needs and the cost benefits to the insurance company, without having to switch to another provider in the network. To lead the negotiation process, the following criteria must normally be met. These include the following factors: if the patient has not had the chance to find a sufficiently qualified network provider, the patient pleads before the start of treatment for an ACS with the out-of-network provider. It is unfortunate that not all insurers offer the same level of coverage and may have their own limited networks for patients. If you become familiar with the case-by-case agreement process, you can support patient care and ensure that they receive the highest level of care. The client has tried and cannot find in their network a practitioner or provider that meets their needs in a way that makes them feel comfortable. In case of treatment with ABA, this should be done before the start of treatment. In an off-grid scenario like this, it`s possible to use a case-by-case agreement to ensure your client has the coverage they need to get the care they rely on from you as a practitioner or therapist.
If you receive an ACS for a current patient for continued treatment, the negotiated rate is based on the patient`s informed consent and consent at the start of treatment with you. Rate increases will be consistent with your pricing policy in informed consent. You can`t charge the patient a lower mobile rate out of pocket and then charge the insurance company your normal full rate if the SCA is back to cover past meetings. Case-by-case agreements must also use ABA CPT authorized medical billing codes. It is important to describe them in the negotiation process with the insurer. This reduces the risk of late claims. When switching to a new network provider, the SCA CPT code may be specific to the number of remaining sessions. Insurers can only assign a specific code for this case or for patients. This is especially true when there is evidence in the past that the person poses a danger to themselves or others, or if they were at risk of suffering a significant setback with their mental health.
Case-by-case agreements are the most common with patients who have identified trust issues and developed a professional relationship with their current ABA provider.. . . .