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Topic: Payors

January Payor Changes: A Provider Problem that is best mitigated with Process

January Payor Changes: A Provider Problem that is best mitigated with Process

Every January, ABA providers face a predictable but still under-managed risk: payor coverage changes that quietly invalidate assumptions made in December. Member IDs may remain the same. The payor brand may not change. But benefits, product structures, authorization requirements, and family financial behavior often do. The result is a familiar

The Invisible Layer in ABA Delivery: Behavioral Health Management Organizations

The Invisible Layer in ABA Delivery: Behavioral Health Management Organizations

When we talk about access to ABA therapy, most people think about two players: the payor (insurance company or Medicaid plan) and the provider (the ABA organization delivering care). But in many markets, there’s a third, often invisible layer that determines how and when therapy actually happens: Behavioral Health

Automation Can Accelerate ABA Billing — But Only If Payor Knowledge Keeps Pace

Automation Can Accelerate ABA Billing — But Only If Payor Knowledge Keeps Pace

Bots, AI, and automation are reshaping revenue cycle management, but clean data and payor expertise still decide who gets paid. For most ABA leaders, the RCM question used to be: Who does the billing? Today, it’s: How well does your billing logic reflect payor reality? This post builds on

Investors Bet on DRBI: Positive Development’s $51.5M Raise and the Tech Behind It

Investors Bet on DRBI: Positive Development’s $51.5M Raise and the Tech Behind It

“The disruptive potential of DRBI isn’t just clinical — it’s in the tech stack required to deliver it at scale.” Context: Why Payors Care About DRBI For years, ABA has been the default therapy for autism. But as Medicaid directors and managed care executives keep reminding us, ABA is

The Nonprofit Giants of ABA: Delivering Care—and Managing a Referral Funnel

The Nonprofit Giants of ABA: Delivering Care—and Managing a Referral Funnel

In autism services, we spend a lot of time talking about PE-backed platforms, for-profit roll-ups, and tech-first startups. But operating steadily in the background—often with less visibility—are the nonprofit giants. Organizations like Merakey, Burrell, Catalight, Bancroft, Easter Seals, Elwyn, Vinfen, Keystone, and Boundless serve tens of thousands of

Detente between Payors and Providers?

Detente between Payors and Providers?

1. A Shift from Defensive Tech to Coordinated Infrastructure? Over the last several years, the relationship between payors and providers has at times resembled an AI-fueled arms race: * On one side, insurers deploy increasingly sophisticated algorithms to flag and deny claims based on pattern recognition and documentation gaps. * On the

AI-Driven Tension: Balancing Payor Budgets and Provider Needs in ABA Therapy

AI-Driven Tension: Balancing Payor Budgets and Provider Needs in ABA Therapy

Recently, Indiana proposed a significant policy change to its Medicaid program: capping Applied Behavior Analysis (ABA) therapy at 30 hours per week, with a maximum duration of three years. This move has sparked widespread concern in the ABA community, particularly because Indiana has historically been a strong supporter of ABA