How to Get Credentialed, Stay Compliant, and Get Paid
Let’s be real—ABA credentialing is a process.
A long, detailed, paperwork-heavy process that feels like applying for a mortgage, but instead of getting a house, you get access to insurance reimbursements and the ability to legally provide services. Not exactly glamorous, but 100% necessary.
If you're an ABA therapy business owner, independent BCBA, or just starting your practice, you need to understand credentialing.
So, let’s break it all down:
What Is Credentialing and Why Do You Need It?
Credentialing for ABA therapy businesses is the process of getting approved by insurance payors so they recognize you as a legitimate provider of ABA services.
Without it, you can’t bill insurance companies—meaning no paycheck, no clients, and no business (unless you only take school contracts or private pay...another blog another day).
Credentialing ensures that your education, licenses, certifications, and professional qualifications meet the standards required by insurers and regulatory agencies. If you don’t get it right, you risk rejected claims, delayed payments, and compliance issues.
Who Handles Credentialing for ABA Therapy Businesses?
Great news—you don’t personally have to do all of this if you don’t want to.
You have options:
✅ Internal Admin Staff – If your practice has an office manager or billing specialist, they can handle credentialing in-house.
✅ Credentialing Consultants – Many ABA practices outsource credentialing to professionals who specialize in dealing with insurance companies and cutting through the red tape.
✅ Do-It-Yourself – If you love paperwork and following up on the phone 17 times or spending hours on hold, you can handle it yourself. (We don’t recommend it, but hey, some people enjoy the challenge.)
How to Get Started with ABA Credentialing
Here’s a step-by-step breakdown of how to get credentialed:
Step 1: Get Your NPI Numbers
Before applying for credentialing, you need National Provider Identifiers (NPIs):
Individual NPI – Required for all providers (BCBAs, BCaBAs, RBTs)
Organizational NPI – Required for businesses or group practices
👉 Where to get it? Apply through NPPES (National Plan and Provider Enumeration System)
Step 2: Register with CAQH
Most insurance companies use CAQH to verify your credentials. Think of it as LinkedIn but for insurance payors.
👉 What’s required?
✅ NPI number(s)
✅ Professional liability insurance
✅ Licenses and certifications (BCBA, LBA, etc.)
✅ Education and training details
✅ Work history and practice information
👉 Where to register? Sign up at https://www.caqh.org/providers
Step 3: Get Professional Liability Insurance
Before credentialing, you must have professional liability insurance in place. Most insurers require $1 million per occurrence and $3 million aggregate coverage.
👉 Where to get it? Companies like CPH & Associates, Hiscox, or Berxi** offer BCBA-specific policies.
Step 4: Submit Applications to Insurance Payors
Now, the fun part—applying to insurance companies. You’ll need to decide which commercial and Medicaid insurers you want to work with. Each has different credentialing processes, contracts, and reimbursement rates.
👉 What’s needed for applications?
✅ NPI numbers (individual & organization)
✅ CAQH profile (fully completed)
✅ Proof of liability insurance
✅ Professional licenses & credentials
✅ Business Tax ID (EIN)
✅ Signed W-9 form
👉 How long does it take? Credentialing can take 90-180 days, depending on the payor. Follow up frequently—because no one else is in a hurry but you.
Step 5: Contracting & Approval
Once approved, you’ll need to review and sign contracts with each insurance company. Read the fine print—make sure you understand rates, billing codes, and compliance obligations.
👉 Pro Tip: Some insurers will negotiate reimbursement rates. If your rates seem suspiciously low, push back and ask for better terms. If you don't negotiate at this point, renegotiating later will be that much harder, if not impossible. (Don't agree to rates that would put you out of business).
How to Maintain Your Credentialing & Keep the Money Flowing
Congratulations! You’re credentialed. Now, don’t mess it up. Credentialing isn’t a one-and-done deal—you have to maintain it.
1. Keep Your CAQH ProView Updated
Insurance payors check CAQH every 90 days—if your information isn’t current, they might drop you.
✅ Log in every quarter
✅ Reattest your profile (confirm nothing has changed)
✅ Update expiring licenses and insurance policies
2. Track Expiration Dates (Licenses, Certifications, Insurance)
If your BCBA certification, state license, or insurance policy expires, your credentialing is immediately invalid. Use a tracking system (ClickUp, Google Calendar, or an Excel sheet) to monitor renewal dates.
3. Re-credentialing (Every 2-3 Years)
Most insurance companies require recredentialing every 2-3 years. This means re-submitting:
✅ Updated liability insurance
✅ Renewed BCBA licenses
✅ Current CAQH profile
✅ Updated tax ID and business details
👉 Pro Tip: Start the re-credentialing process at least 6 months before your expiration date to avoid coverage lapses.
Final Thoughts: Make Credentialing Work for You
ABA credentialing is a pain, but it’s essential for running a legitimate practice and getting paid. Whether you handle it yourself, hire an admin, or outsource it, make sure it’s done right the first time.
Need help?
Consider working with a credentialing consultant or a billing service that offers credentialing support. You’ll save time, reduce stress, and ensure you’re always ready to bill and get paid.
TL;DR (Too Long; Didn’t Read)
✅ Get NPI numbers from NPPES
✅ Register with CAQH
✅ Obtain professional liability insurance
✅ Submit applications to insurance payors
✅ Maintain CAQH & credentials quarterly
✅ Re-credential every 2-3 years
🚀 Want a shortcut? Work with a credentialing expert and skip the headaches.
Got credentialing horror stories? Drop them in the comments—we could all use a laugh. 😅
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