Providers and Assisting Providers

The purpose of this blog is to assist providers on obtaining insurance reimbursement for the treatment of Autism Spectrum Disorder Therapies (ASD). Please feel free to add your comments, suggestions, and personal experiences with different insurance carriers.

Saturday, February 26, 2011

Where to find fee schedule for BCBSFL

In follow up to our blog last week we want to help in finding the fee schedule for BCBSFL. Go to Once there you click on the provider tab. Click on the tools & resources link. Next go to provider manuals prior to 10/30/10. On this page scroll down to Ancillary Providers link PDF file. While in this file go to page three and click on the Ancillary Common Fee Schedule. On this next page click on May 2010 under the Behavioral Health section. On this page you will see the codes 96150 & 96152. These are the ABA therapy codes for billing. If you do not have a CPT code book yet it is suggested you get one to find the descriptions of the codes. As you know by now each insurance company is giving different codes for our services therefore it is important to know the descriptions and billing frequency for the codes.

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Friday, February 18, 2011

Codes for Blue Cross & Blue Shield of Florida

i have received some emails regarding what are the codes for Blue Cross & Blue Shield of Florida for ABA therapies. The following are the billing codes 96150-assessment,96152-therapy. You can find this information on Find the "for providers" tab. Click tool and resources. Go to provider manuals. In part II find Ancillary Providers and click to open PDF file. You can find the codes on page 9. BC & BS will pay 70% of the allowable. Look for our next tweet or blog for the fee schedule.

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Saturday, February 12, 2011

Parker Autism Foundation

In our constant search to assist the many children who are need of financial assistance to receive ABA therapy we found The Parker Autism Foundation Here families are able to apply for a limited scholarship for ABA therapy at the Parker Autism Foundation or an approved center.

All information is available at, scroll down to the bottom of the page and read the FAQ's. There is a downloadable and printable application with instructions.

We will continue to inform families on additional funding information as we discover them. We hope this is helpful.

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Location:Torremolinos Ave,Doral,United States

Saturday, February 5, 2011

Where have we been?

I would like to apologize for not blogging for quite a while. During the past year we have had an increase in the number of insurance companies that have credentialed us or we are working on a case by case assignment. We have been able to add Blue Cross & Blue Shield, Aetna and UBH. As you all know there are many different codes for our service depending on the insurance providers. We have now also learned that there are many different guidelines for service, depending on the insurance provider or carrier. these guidelines appear to establish medical necessity for or clients. Failure to meet medical necessity guidelines will result in the termination of case.

So, if you are going to take on any new cases from new insurance providers we suggest the following:

1. Contact provider relations representative to see if you can get a copy of the guidelines.
2. Do some online research for the documentation.
3. Review the documentation to develop a checks and balances on what activities must occur so that you may stay in compliance with the insurance provider or carrier. this could be done by creating a super-bill that includes all of the activities that BCBA must do on a monthly basis and a template for the quarterly or six month reviews that reflect the actions of the BCBA and your line-staff.

I currently have the guidelines for Cigna, Aetna, UBH and Humana Tricare. I am currently looking for Humana, AvMed, & Blue cross & Blue Shield.

If you have any questions, or info please post them on the blog or email me at Please subject your emails, Attn. Jose & Cary Blog questions.

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Location:SW Shannon Ave,Melbourne,United States

Wednesday, April 21, 2010

Watch Your Claims and Modifiers!!!

Just a quick note to advise all of you providers who are currently billing insurance companies, Watch Your Claims and Modifiers. Whenever you get a billable code from an insurance company, have them verify verbally and especially in writing what modifiers must be used and how! We had been submitting claims with the codes given to us as billable this year. After numerous claims submitted since February, we still have not been reimbursed for our services. It appears that we did not use modifiers on our claims. WHAT!!! You can imagine how we reacted! We immediately started an email and phone communication to get this problem resolved. It has been a struggle but there seems to be a light at the end of the tunnel. It appears that there was a failure in the communication trail which resulted in our claims being held up. We are now submitting claims religiously every week with the correct modifiers. The moral of the story verify your codes and modifiers!!!

Thursday, February 18, 2010

An update on our insurances

Things have been moving right along for us. We have now gotten a Mental Health (MH), Aetna, and Cigna Contract, and are awaiting our provider number. We also have two clients with United Behavioral Health already after contracting. Currently we are awaiting word on BCBS and Avmed, and should know the status tomorrow or Monday.

This is exciting news as we have made major progress in obtaining contracts with different insurances. If anyone has any questions or comments about any insurances feel free to leave a comment below. You can also email us at

How is everyone else doing with insurances in this new year? Let us know and we can assist each other!

Friday, January 29, 2010

Insurance Updates

As the new year came in, so did new insurance contracts for our company. In the last months of 2009, our therapists became credentialed using CAQH, and we started being contacted by several insurance companies to see if our therapists are credentialed. Having therapists who are credentialed has helped secure a contract with Aetna, and we are waiting on word from Avmed at this time. Our therapists that are credentialed now appear in the therapist search on Cigna's behavioral website.

We are currently working with Tricare (Humana Military) and Cigna, and working on getting in with PsychCare, United Behavioral Health, and BCBS. Our applications are in and currently being reviewed. Something to share with everyone is that we have been in contact with Magellan, and they have said they are not covering behavioral services.

Now that the new year is here, has anyone else made moves for more insurance companies? If you have any questions or any information, please feel free to comment. Also, you can always contact us at