SCAs is also known as Single Case Agreements, are contracts between an insurance agency and an out-of-network therapist. These kinds of agreements regularly cover a particular client getting assistance for an assigned measure of time at a settled-upon rate. As of lately, most payers assumed the job of arranging rates for SCAs; be that as it may, numerous payers are currently done arranging these case premise rates, and subsequently, are paying the most elevated in network-level expenses.
Let’s dive into the most common questions, we at Amromed are asked regarding SCAs:
When does a patient need SCA?
In the ABA sector, it might be laid out when a patient can’t get something similar or tantamount assistance from an in-network supplier. On the off chance that a patient’s necessities require particular assistance and an in-network supplier isn’t accessible inside a sensible measure of time or vicinity from the patient, an SCA can be considered to compensate for the absence of accessibility. These arrangements may likewise be permitted assuming a patient has as of late changed payor network and needs continuous treatment with a particular supplier that is out-of-network with the new insurance agency.
Why would a therapist or provider want an SCA?
On multiple occasion a therapist may want to continue working with a patient even after they have switched insurance yet the provider falls in the out-of-network bracket. Two basic scenarios of the general qualification include the temporary processing period until a specific provider is contracted as in-network with the new insurance, or until a patient is transferred to another in-network provider. When a therapist is in the last few stages of processing to an in-network status, they may obtain a SCA for a few months until credentialing is completed.
It’s common for single case arrangements to make up for administrations in manners considerably more engaging than those accessible by in-network suppliers. Presently, numerous payers offer SCA remuneration at the most competitive rate on the higher side, however, permitting patients to proceed with admittance to their in-network helps along these lines bringing about less monetary obligation regarding the patient.
When a therapist is provided Single Case Agreements, then why would they want to become in-network providers?
Mostly, insurance companies have a list of contracted therapist within a locality; and the insurance will not offer single case agreements if they feel that enough therapist are already available to meet their patients’ needs. Other insurances such as Medicaid or additional government entities only offer in-network benefits, so SCAs are less likely to be an option. For small clinics with fewer clients, it can be advantageous to be selective about which insurance networks you wish to be contract with.
Single Case Agreements, Is there more to it?
Single Case Agreements is the best alternative for patients and/or guardians to help facilitate with insurance companies. If a patient’s request for an SCA can explain and support in detail why a specific therapist is better qualified to meet their procedural needs than an in-network provider, this can help justify, the need for a SCA. Few reasons that can support the need for an SCA include: extended wait times for services, distances between POS and patient, or that there is not a therapist specialized enough to provide the right treatment.
It is mandatory that you obtain all documentation and have a clear understanding of the conditional terms of the SCA, some of which aspects include authorization requirements or prior approval of services, duration of services allowed, payment terms, and billing requirements.
Mostly all insurance companies don’t provide a physical version of a SCA document, hence detailed clinical information needs to be documented and maintained as part of medical protocol, which helps that justification in case of cross-reference while auditing.
One a last note always be cautious of the extended periods of time that is needed to obtain a SCA. As a therapist, you would want to pace out and coordinate the services in advance to request approval of the SCA; If an agreement to provide services during the time of SCA consideration is set, make sure a well written financial agreement with the patient is in place for any reason should the insurer come back and not cover the services provided.
We at Amromed are experienced in helping therapists obtain the highest compensation for SCA. We provide proper guidance in clinical documentation and handle the administrative aspects to make sure that you can have an undivided focus on your patients’ care while we focus on obtaining your claim. We provide you with the most updated insight into when it is more advantageous to remain out-of-network versus when it might be better to remain in-network.