Free resource for CASP members

Payer rates for ABA providers

Juniper and The Council of Autism Service Providers (CASP) have created a special collaboration to bring CASP members exclusive access to Juniper's proprietary payor rate data asset.

As a CASP member, you'll be able to view ABA-specific reimbursement rate analyses for one of 40 payors of your choosing within states you provide services.

But what is payor rate data, who can access it, and why does it matter? Learn more about the recent regulation that makes this data available, and how these changing policies are impacting the ABA industry.

We're also looking for your feedback so we can improve this resource for the entire community. Do you see your own rates represented accurately? Please let us know!

Get the data Become a CASP Member
In 2020, the Transparency in Coverage final rule released by the Department of Health and Human Services (HHS) required insurance payors to disclose price information to the public.

Before this ruling in October 2020 (CMS-9915-F), insurance payors were able to use antitrust laws to withhold the rates they paid individual providers from the public. This new ruling mandated that all health plans must share their contracted rates for all providers, starting in July 2022.

Unfortunately, this data remains inaccessible for most providers.

While the HHS ruling mandates that insurance payors disclose rate files publicly on their websites, the CMS itself also acknowledges that "specific technology may be needed to download and read these files given their size and complexity" (source).

For instance, UnitedHealthcare maintains ~42K files worth of data, many of which are too large to download onto most personal computers, much less analyze individually.

So while rates are technically available, they're not useful for the vast majority of providers that don't have dedicated technology teams and resources.

As an ABA-specific technology firm, we've been able to extract, analyze, and visualize insurance rate data for ABA providers.

Take the graph on the page, which visualizes in-network 97153 reimbursement rates for Aetna in Arkansas.

The X axis gives the maximum reimbursement rate per 15-minute 97153 unit, which ranges from $10.75 to around $19. The Y axis shows the approximate number of NPIs credentialed with that rate. The taller the bar, the more common that rate is for Aetna providers in Arkansas.

From this, we can infer that many providers may be reimbursed up to $33 per hour less than other providers.

*We've compiled this data from insurance payor machine-readable files, the NPPES database, and other demographic datasets. While the names of individuals providers are included in the public dataset, we've aggregated the data by region for privacy reasons.
ABA providers can leverage this data to understand and strategize potential reimbursement rates specific to their insurance payors and service regions.

These insights can be an asset during the contracting and credentialing process.

Providers can also gain pricing information in neighboring geographies to help strategize how they might best serve certain regions sustainably.

*Insurance payors each have their own contracting and credentialing process, for which there can be many factors that determine negotiated rates.
Get the data
Credentialing tips summary
Join CASP
We've collaborated with CASP to give its members access to this data asset at no cost, and we're asking for your feedback.

CASP members will be able to select one payor out of Juniper's database of 40+ funders (including Aetna, Cigna, United Healthcare, and Medicaid), and Juniper will provide aggregated data analysis for that payor free of charge.

But our data is only as accurate as insurance payors choose to disclose, and we're looking for your feedback to make it better. Do you know of rates that are not represented in the datasets as expected? Please let us know so that we can improve this resource for all of us in the community.

*Juniper is continuously expanding its coverage of payors across different states. In the case that we don't have access to your specific payor region dataset today, your request will help inform where we prioritize our future coverage.

The Council of Autism Service Providers (CASP) is a non-profit trade association of provider organizations serving individuals with autism spectrum disorder. Learn more at casproviders.org.

Juniper is a technology firm that builds automated, full-service billing for ABA, OT, & SLP providers. Learn more at juniperplatform.com.

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CASP is a nonprofit tax-exempt trade association and CASP activities must be conducted in accordance with all applicable laws and CASP policies. CASP's Antitrust Policy requires CASP members to comply with applicable laws, including antitrust laws, which prohibit agreements on price or compensation factors. Please note that the information provided by CASP is presented for general information and educational purposes only. Any information presented is not intended to, and should not, play any role in anticompetitive agreements on price or compensation or restricting competition in the industry or profession. All decisions regarding prices, fees, salaries, or compensation must be made individually and not in concert with others in the industry or profession.
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Sources:
Transparency in Coverage Final Rule Fact Sheet (CMS-9915-F)
Transparency in Coverage (CMS-9915-F)
National Plan & Provider Enumeration System

This example graph shows 97153 max rates for Aetna Arkansas, ranging from $10.75 to $19, and the number of NPIs credentialed with each rate. The taller the bar, the more common the rate.