This episode provides behavior analysts with practical guidance on navigating insurance authorization processes, with particular focus on peer review procedures. The panel discusses the workflow from initial clinical review through potential peer review, emphasizing that peer review is a collaborative process rather than punitive action. Key topics include understanding medical necessity requirements, writing effective treatment plans, preparing for peer review conversations, and managing different outcomes. The discussion addresses common challenges faced by both new and experienced BCBAs, including dosage recommendations, goal writing, parent involvement requirements, and handling denials. This content directly supports behavior analysts in improving their clinical documentation and communication skills to ensure continued access to services for their clients.

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Show Notes

References:

Reinecke, D. R., & Colleagues. (2024). Treatment planning recommendations for applied behavior analysis services. Association for Professional Behavior Analysts.

Resources:

Professional Organizations and Guidelines:

• ABA Coding Coalition - https://abacodes.org

• Association for Professional Behavior Analysts (APBA) - http://www.apbahome.net

• Council of Autism Service Providers (CASP) ABA Practice Guidelines - https://www.casproviders.org/asd-guidelines

Training and Educational Resources:

• Autism Law Summit ABA Authorization and Appeals Playbook

• CentralReach Institute

• CR Unite Conference

Assessment Tools:

• WebABLLS (Web-based ABLLS-R program) - http://webablls.com