| Autor: |
Papatola KJ; Cigna, 11095 Viking Dr., #350, Eden Prairie, MN 55344 USA., Lustig SL; Cigna, 400 N. Brand St., 3rd Floor, Glendale, CA 91203 USA. |
| Jazyk: |
angličtina |
| Zdroj: |
Behavior analysis in practice [Behav Anal Pract] 2016 Apr 01; Vol. 9 (2), pp. 135-45. Date of Electronic Publication: 2016 Apr 01 (Print Publication: 2016). |
| DOI: |
10.1007/s40617-016-0120-5 |
| Abstrakt: |
As autism rates increase, providers of applied behavioral analysis (ABA) services are more frequently engaging with managed care companies to discuss the medical necessity of treatment. In an effort to maximize the efficiency and effectiveness of these reviews, we draw upon our experience as peer reviewers for a managed care company to guide ABA providers in discussions with managed care on behalf of their patients. In this article, we first provide an overview of the managed care peer review process. We then discuss the elements of medical necessity that managed care companies ask about during the review process. Finally, we review specific strategies that ABA providers can use during the process to optimize authorizations for payment for services. Throughout the paper, we provide sample dialogues between providers and peer reviewers based on our experience working for a managed care company along with specific recommendations that we hope will ensure a more collegial and effective peer review process for all involved. |
| Databáze: |
MEDLINE |
| Externí odkaz: |
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