Consultation for Insurance Agencies, EMR Platforms, 3rd Part
Ins and Outs of Applied Behavior Analysis
Ontogenesis provides targeted consultation services for insurance payers, EMR (Electronic Medical Record) providers, and third-party billing platforms (RCM) seeking to align more effectively with the operational, clinical, and regulatory realities of Applied Behavior Analysis (ABA) service delivery.
With decades of experience in ABA clinical leadership, systems design, and payer collaboration, our team bridges the critical knowledge gap that often exists between funders, billing systems, and ABA service providers. Many insurers, EMRs, and billing platforms struggle to fully grasp the nuances of ABA—including certification standards, tier-based service delivery, proper code utilization, and outcome-based care models.
We offer:
- BACB Standards & Certification Clarity
We explain the roles and credentialing of BCBAs, BCaBAs, and RBTs, outlining how these affect service authorization, supervision requirements, and compliance with BACB standards.
- Tier-Based Clinical Model Design
We guide stakeholders in understanding how ABA services are structured by clinical intensity and staffing levels, helping build scalable, ethical, and cost-effective care frameworks.
- Code Utilization & Billing Logic
For EMR developers and billing platforms, we provide deep insight into CPT code application (e.g., 97151, 97153, 97155), helping systems align coding logic with clinical intent, FBA/FA requirements, supervision layers, and parental involvement standards.
- Telehealth Integration
As pioneers in telehealth ABA since 2015, we help platforms and insurers assess quality controls, telehealth readiness, and delivery models that ensure access without sacrificing clinical fidelity.
- Outcome Measurement & Authorization Support
We advise on building systems and workflows that track meaningful progress, support proper treatment plan design, and improve authorization accuracy through data-driven, child-centered metrics.
By partnering with Ontogenesis, insurance providers, EMR developers, and billing platforms gain the necessary knowledge to create tools, systems, and policies that reflect best practices in ABA. Our consultations promote service integrity, reduce administrative burden, and help all stakeholders make informed, sustainable decisions that support access, equity, and clinical quality.
