What needs to be taken into account when approving individual case agreements, if you get approval of an agreement on a case-by-case basis, can be a tedious and frustrating task. Our mission is to help you. However, if the SCA has been approved, our task is not complete. Here, we need your support to take into account the following aspects: As an ABA treatment provider, you may want to consider negotiating a single case agreement (SCA) to provide services to a patient. These agreements exist between insurance companies and off-grid providers (OONOs) for which OON is recognized as an in-network provider (D.D.D. While it is usually the patient who asks his insurer for the SCA, on the basis that there are no other INN providers for ABA therapy in their field, your agency still has to agree on the terms and rates for the services provided. Since insurers are not legally required to provide an CAS, it is essential for you to present them with the benefits of providing you with this opportunity. Keep in mind, however, that if you provide the reasons for the need for an SCA, it remains honest and justified. To beautify is to cheat.
The application for an SCA is usually in two categories: the new client or the current patient. If you are trying to get an ACS for a new patient, you should consider considering the need of the patient (family) for your specialty and the benefit of your closeness to them. If you help a current patient apply for an CAS from a new insurer, you justify the need for the agreement by insisting on continuity of care. Also keep in mind that you must have defined your patient`s financial responsibility to your agency until an CAS is issued. You may decide not to provide services until the CAS has been authorized or you can agree on a financial agreement for meetings that are not covered by the agreement (just because an CAS is in good standing does not mean that it will be backdated). Always ask for an SCA for the OON plans you work for to get permission. Consider the following strategies to help you get a single case agreement: If the patient has not had the chance to find a sufficiently qualified network provider, then the patient pleads for an SCA with the network provider out before the start of treatment. What is the extent of the single box agreement We have already mentioned how you should focus on the services included in the agreement. If your patient needs multiple treatments and therapies, the contract must cover reimbursement for all treatments or the maximum number of treatments. It should be noted that insurance companies have a legal obligation to properly treat patients by well-trained professionals. Therefore, if the insurance plan does not cover off-network services, and there are no in-network providers with the specified specialty, then you, as a qualified provider, can negotiate your usual full fees as a meeting rate for new patients.
This is because the patient does not simply choose to see you, but is forced to deal with insufficient providers in the network. In this case, the patient usually makes the case with the assurance of an ACS with you before starting treatment. Sometimes an insurance company may have a “payment policy with the highest in network rate,” in which case you will not be able to negotiate the rate. You still have the option to refuse the SCA if the sentence and conditions are not acceptable to you. What are the conditions that patients must meet in order to reach an agreement on a case-by-case basis? To obtain a case-by-case agreement, you, as a health care provider, must commit to billing your patient with the insurance company. The goal of the SCAs is to meet the important needs of the patient; billing costs a network provider more than a network provider.