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Category: RCM

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

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

The Hours Are Approved. So Why Aren’t They Delivered?

The Hours Are Approved. So Why Aren’t They Delivered?

In ABA, the prescription is therapy time—authorized hours of care that a child needs to make progress. When those hours go undelivered, it’s not just a billing issue. It’s not just an ops issue. It’s a clinical failure. A child who could be gaining communication skills,

Silna’s $27M Raise Signals a Shift in How Providers Handle Prior Auth

Silna’s $27M Raise Signals a Shift in How Providers Handle Prior Auth

Silna Health recently emerged from stealth with $27 million in Seed and Series A funding, co-led by Accel and Bain Capital Ventures. Their mission? To eliminate one of the biggest operational burdens in healthcare: the administrative chaos surrounding prior authorizations, benefit checks, and eligibility workflows. I had the opportunity to

A Deep Dive into Camber (aka Juniper)

A Deep Dive into Camber (aka Juniper)

A Deep Dive into Camber (previously known as Juniper Platform) Camber’s $30M Series B investment and rebrand from Juniper Health highlight a strong bet on revenue cycle management (RCM) as a high-value sector in healthcare. With higher margins and direct financial impact, RCM solutions like Camber’s appeal to

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

Comprehensive Guide to ABA Technology Platforms for Service Providers

Comprehensive Guide to ABA Technology Platforms for Service Providers

Mapping the ABA Technology Landscape At ABA Mission, we’ve been working to develop a Technology Landscape for ABA Providers—a comprehensive overview of the platforms and tools that support ABA organizations in delivering exceptional care. While technology offers significant opportunities for efficiency and growth, managing and integrating these solutions