## 1. Potential Points of Confusion ### A. Differentiating BCBA Certification from State Licensing - **Why It’s Confusing**: BCBAs might think having their BACB certification is enough everywhere. However, certain states also require a separate, state-issued behavior analyst license. - **Clarification**: You must check your specific state’s licensing board or psychology board website. Some states do not require an additional license if you’re a BCBA in good standing; others do. ### B. Navigating the Type 1 vs. Type 2 NPI - **Why It’s Confusing**: A BCBA might have only heard about a personal NPI (Type 1) and wonder why a second one is needed. - **Clarification**: - **Type 1 NPI**: For you as an individual provider, needed if you’re billing under your own name. - **Type 2 NPI**: For the business entity (e.g., an LLC or Corp), needed if you want reimbursements to go to the company rather than you personally. - **Watch Out**: When enrolling with payers, you’ll link your personal NPI with your business’s NPI (if you’re billing under the business name). ### C. The Medicaid vs. MCO Maze - **Why It’s Confusing**: States differ a lot—some have a single Medicaid system, others use multiple managed care organizations. - **Clarification**: You may need to enroll with each MCO that operates your state’s Medicaid program. Application requirements can vary. Track them carefully—spreadsheets help. ### D. Insurance Credentialing vs. Contracting - **Why It’s Confusing**: Often used interchangeably, but they’re two steps: 1. **Credentialing**: Verifying your license, background, etc. 2. **Contracting**: Finalizing your reimbursement rates and network agreement. - **Clarification**: You’re not truly “in-network” until both are done. Expect multiple weeks/months of back-and-forth. ### E. Clearinghouses, EDI, and Billing Codes - **Why It’s Confusing**: Terms like “837 files,” “835 remittance,” “Office Ally,” “Availity,” “modifiers,” etc. can overwhelm someone new to medical billing. - **Clarification**: - A **clearinghouse** is essentially a claims-sending middleman that checks for errors. - **837** is the electronic claim format; **835** is the remittance advice telling you what’s paid or denied. - For ABA, **CPT codes** 97151–97158 are key, with potential modifiers for telehealth or technician services. ### F. Policies vs. Procedures vs. SOPs (Standard Operating Procedures) - **Why It’s Confusing**: Some BCBAs lump everything into one binder or folder. - **Clarification**: - **Policies** state the overarching rules (e.g., “We follow HIPAA guidelines”). - **Procedures** detail the **how-to** (e.g., “Here’s how we collect session data, step by step”). - **SOPs** might merge both or be a single reference doc. The important part: ensure staff know them and can apply them consistently. ### G. Understanding “Going In-Network” vs. “Out-of-Network” or “Private Pay” - **Why It’s Confusing**: Some BCBAs worry about whether to jump through all the hoops of credentialing or to just charge families directly. - **Clarification**: - **In-network**: Larger client pool, more admin complexity, slower reimbursements. - **Out-of-network**: Less paperwork, but families pay you and may seek partial reimbursement from their insurer. - **Private-pay only**: Simplest for you, but drastically limits your client base unless you’re in an area where families can afford out-of-pocket fees. ### H. Growth Models: Telehealth, In-Home, or Opening a Clinic - **Why It’s Confusing**: Each model has different overhead, licensing, scheduling logistics. - **Clarification**: - **Telehealth**: Less overhead, specialized telehealth coding or place-of-service rules. - **In-home**: Travel costs/time, staff safety considerations, in-home note-taking or tablet-based data collection. - **Clinic**: Leasing space, extra facility licensing, a place to run social skills groups, a more centralized business approach. ### I. Marketing Tactics and Ethical Boundaries - **Why It’s Confusing**: Healthcare marketing has different rules than typical businesses (e.g., you can’t pay for referrals). - **Clarification**: - **Ethical**: Provide information, not bribes. - **Effective**: Focus on relationships, community presence, and clear online information about your services. ### J. Knowing Where to Get Official Forms & Info - **Why It’s Confusing**: Each step—NPI, Medicaid enrollment, licensing—might be on a different website. A new BCBA might not know which sites are official. - **Clarification**: (See next section for direct links.) --- ## 2. Key Resources and Where to Sign Up Below are **direct sites** and **resources** covering the critical sign-up or application processes mentioned throughout the guide. 1. **BCBA Certification** - **Behavior Analyst Certification Board (BACB)**: [https://www.bacb.com](https://www.bacb.com) - Renewals, CEU requirements, ethics code, verification of credential status. 2. **State Behavior Analyst License** - Search: “Behavior Analyst License + [Your State].” - Or check the **BACB’s list of licensure board contacts**: [https://www.bacb.com/u-s-licensure-of-behavior-analysts/](https://www.bacb.com/u-s-licensure-of-behavior-analysts/) (This link offers an overview of states with licensure requirements and who to contact.) 3. **NPI Number** - **National Plan & Provider Enumeration System (NPPES)**: [https://nppes.cms.hhs.gov](https://nppes.cms.hhs.gov) - Apply for Type 1 (individual) or Type 2 (organizational) NPIs. 4. **Medicaid Enrollment** - Varies by state. Example portals: - **California**: PAVE (Provider Application and Validation for Enrollment) [https://pave.dhcs.ca.gov](https://pave.dhcs.ca.gov) - **Texas**: TMHP (Texas Medicaid & Healthcare Partnership) [https://www.tmhp.com](https://www.tmhp.com) - **Florida**: Florida Medicaid Provider Enrollment [http://mymedicaid-florida.com](http://mymedicaid-florida.com) - Or just Google: “Medicaid provider enrollment + [Your State].” 5. **Managed Care Organizations (MCOs)** - Typically found by visiting your state’s Medicaid site or a “List of MCOs in [Your State].” - Each MCO usually has a “Provider Enrollment” or “Join Our Network” page. 6. **Commercial Insurance Credentialing** - **CAQH ProView**: [https://proview.caqh.org](https://proview.caqh.org) - Create or update a profile so private insurers can pull your information. - Major payers each have a “Provider” or “Network” page: - **Aetna**: [https://www.aetna.com/health-care-professionals/join-the-aetna-network.html](https://www.aetna.com/health-care-professionals/join-the-aetna-network.html) - **Cigna**: [https://www.cigna.com/health-care-providers/join-our-network/](https://www.cigna.com/health-care-providers/join-our-network/) - **UnitedHealthcare**: [https://www.uhcprovider.com/en/resource-library/Join-Our-Network.html](https://www.uhcprovider.com/en/resource-library/Join-Our-Network.html) - **Anthem/Blue Cross Blue Shield**: (Varies by state; Google “Join Anthem/BCBS [Your State] provider network.”) 7. **Clearinghouse Solutions** - **Office Ally**: [https://cms.officeally.com](https://cms.officeally.com) - **Availity**: [https://www.availity.com](https://www.availity.com) - **Waystar** (ZirMed): [https://www.waystar.com](https://www.waystar.com) - **Change Healthcare**: [https://www.changehealthcare.com/solutions/medical-network-services](https://www.changehealthcare.com/solutions/medical-network-services) 8. **HIPAA Compliance Resources** - **HHS (Health & Human Services) HIPAA Portal**: [https://www.hhs.gov/hipaa/index.html](https://www.hhs.gov/hipaa/index.html) - Official guidance on Privacy & Security Rules, breach notification, and FAQs. - Many “HIPAA compliance checklists” exist, but always cross-reference with official HHS documentation. 9. **ABA Practice Management Tools** - Typically found by searching “ABA EHR” or “ABA practice management software”: - **CentralReach**: [https://centralreach.com](https://centralreach.com) - **Rethink Behavioral Health**: [https://www.rethinkbehavioralhealth.com](https://www.rethinkbehavioralhealth.com) - **WebABA**: [https://webaba.com](https://webaba.com) - Most have built-in clearinghouse or RCM integrations and can direct you to sign-up instructions. 10. **Small Business Registration** - If you’re forming an LLC or corporation: - **Stripe Atlas**: [https://stripe.com/atlas](https://stripe.com/atlas) (for a Delaware C-corp or LLC) - **Your State’s Secretary of State website** for direct filing. - **IRS EIN Application**: [https://www.irs.gov/businesses/small-businesses-self-employed/how-to-apply-for-an-ein](https://www.irs.gov/businesses/small-businesses-self-employed/how-to-apply-for-an-ein) --- ## Final Thoughts Even with thorough step-by-step instructions, **every provider’s situation** can have unique twists—whether due to state-specific rules, the type of services offered, or personal preference on business structure. Having a **one-stop list** of resources (like the links above) will save a lot of time googling and guesswork. Remember: - **Don’t be afraid to call or email** your state’s licensing board, Medicaid office, or major insurers. They often have provider relations reps who can clarify application requirements. - **Local BCBA colleagues** or state ABA associations are also invaluable for practical, on-the-ground tips. - **Consult professionals** (healthcare attorney, accountant, or specialized consultant) if you’re unsure about the legalities or financial complexities. Combining the step-by-step guide with these clarifications and resource links should give a **new BCBA business owner** a strong, actionable roadmap to build, launch, and grow an ABA therapy practice.