Group vs. Individual Credentialing: A Complete Guide for ABA Therapy Practices

Credentialing is one of the most important steps in setting up an ABA therapy practice that accepts insurance. It verifies our qualifications, licenses, and background, allowing us to become part of insurance networks and bill for therapy services. 

By understanding the differences between group and individual credentialing, ABA professionals can choose the right approach for their practice, avoid costly delays, and ensure smooth reimbursement.

What Is Credentialing in ABA Therapy?

Credentialing is the process by which insurance companies confirm a therapist’s education, professional license, certifications, and background before granting them network participation status. In ABA therapy, this means verifying credentials for Board Certified Behavior Analysts (BCBAs), BCaBAs, and Registered Behavior Technicians (RBTs).

The outcome of this verification is network status—a provider becomes “in-network,” eligible to bill payers, and listed in directories so clients can access therapy with insurance.

Credentialing also determines fee schedules for reimbursement and ensures compliance with state and federal programs like Medicaid and Medicare. Without proper credentialing, providers can’t receive reimbursement from insurance payers, even when their ABA billing is accurate and complete. For new practices, our ABA Credentialing Made Simple guide explains how to simplify the entire setup process.

ABA Credentialing Service for Individual Providers

Individual credentialing focuses solely on the therapist. It’s ideal for independent BCBAs who bill under their personal NPI (Type 1) and manage their own payer relationships.

Key details:

• Applications are submitted to each insurance company individually.

• Contracts are tied to the provider’s name, NPI, and personal tax ID.

• CAQH attestation and license updates must be maintained personally.

• Claims are billed directly under the individual contract.

The timeline for approval varies by payer—typically 60–90 days for most commercial insurers, up to 120 days for Medicare, and around 100 days for Medicaid enrollment, depending on documentation accuracy.

This approach offers independence and flexibility but can become time-consuming if the provider joins several payers.

ABA Credentialing Services for Group Practices

Group credentialing, often called a group contract, is designed for practices that operate under a single business entity. Let's have an entire ABA practice enroll under one EIN and Type 2 NPI, with each clinician connected through their Type 1 NPI. The payer contracts with the practice, not each clinician, creating a unified and efficient setup.

How It Works

When a payer contracts with your practice, the agreement applies to the organization as a whole, not to each clinician individually. This means that:

• Fee schedules and participation status are standardized across the group, ensuring consistent reimbursement rates.

• New clinicians can be added through a streamlined group application that links them to existing payer contracts.

• Claims and billing are submitted under the group’s NPI, making reporting, payment posting, and compliance tracking more efficient.

How the Credentialing Process Works for Group and Individual Providers

Whether you’re an individual ABA therapist or part of a group practice, the credentialing process follows the same key stages. Each step ensures that you’re properly verified, approved by insurance payers, and ready to provide reimbursable services. For a deeper walkthrough of each step, view our full step-by-step credentialing guide.

Preparation

     Gather your licenses, BCBA certificate, malpractice insurance, CAQH profile, résumé, W-9, and background check. Double-check everything before applying—missing or outdated documents often slow down credentialing approvals.

Submission

    Send your applications to each insurance payer or portal. Keep records, follow up regularly, and make sure all details match across forms to prevent unnecessary processing delays.

Verification

    Payers review each document, confirm NPIs and licensing, and ensure consistency between the CAQH, application, and state databases. Even small discrepancies—like mismatched addresses or missing signatures—can delay approval.

Contracting

    Once verified, you’ll receive a participation contract showing your rates, fee schedule, and renewal terms. Group practices link clinicians under one NPI, simplifying network enrollment. Learn how contracting and credentialing relate and what to watch for when comparing agreements.

Onboarding and Maintenance

     After network approval, maintain compliance through ongoing monitoring, timely renewals, and quarterly CAQH attestations. Missing revalidation dates or failing to submit re-credentialing updates can lead to suspended billing privileges.

NPIs in Credentialing: Type 1 vs. Type 2

The National Provider Identifier (NPI) is essential for both credentialing and billing.

• Type 1 NPI: For individual therapists such as BCBAs and RBT supervisors.

• Type 2 NPI: For the business entity or organization.

When credentialing with insurance companies, both identifiers may appear: the Type 2 for the group entity and the Type 1 for the servicing provider. This ensures correct claim routing through clearinghouses and practice management systems.

How Does a Tax ID Link ABA Providers to Payers?

A Tax ID (EIN) connects the business entity to all affiliated clinicians. In group credentialing, each provider’s Type 1 NPI links to the group’s EIN and Type 2 NPI. This structure allows payers to recognize the organization as the billing entity.

Independent therapists who operate as sole proprietors may initially bill under their SSN, but should obtain a tax ID as they grow for liability and professional reasons.

Real-World Example

A mid-sized ABA clinic operating across two states managed credentialing manually for its 12 BCBAs. Each therapist handled their own payer submissions, resulting in inconsistent data and delays. After consolidating under a group contract with a single Tax ID and Type 2 NPI, approval times dropped by 30%, and reimbursement speed improved significantly.

Not sure if your clinic is ready for this level of organization? Find out here to gain clarity and confidence in your credentialing process.

Documents Required for Both Individual and Group Credentialing

Both models require similar verification items, including:

• Active state license(s)

• Proof of professional liability insurance

• CAQH profile and attestation confirmation

• W-9 form with tax details

• Resume and education verification

• Criminal background check

• Certification copies (e.g., BCBA or BCaBA)

Incomplete or inconsistent paperwork is one of the main causes of payer delays. Submitting organized, error-free documentation speeds up approval, ensures compliance, and prevents claim denials once billing begins.

In short, strong document management is the backbone of a smooth credentialing process—whether you’re credentialing one therapist or an entire ABA practice.

Factors to Consider When Choosing Between Group and Individual Credentialing

Choose individual credentialing if:

• You operate independently as a BCBA.

• You want direct control over payer relationships and rates.

• You plan to stay a solo practitioner.

Choose group credentialing if:

• You manage multiple clinicians or plan to expand.

• You prefer unified billing under one tax ID.

• You want faster onboarding for new staff through linked contracts.

For growing ABA practices, group credentialing often provides long-term efficiency by consolidating contracting and improving coordination across teams.

FAQ

1. What is the difference between group and individual NPI?

A group NPI identifies the practice or organization, while an individual NPI represents one therapist who provides services directly to clients.

2. How difficult is medical credentialing?

Credentialing can be time-consuming because each payer has different requirements, forms, and timelines, but organized documentation and follow-ups make it much easier.

3. What is credentialing in ABA?

Credentialing in ABA verifies a provider’s license, certification, and background so they can join insurance networks and get paid for therapy services.

Conclusion

Choosing between group vs individual credentialing is more than an administrative decision—it shapes your billing flow, compliance, and practice growth. Solo BCBAs benefit from the independence of individual credentialing, while growing clinics thrive under the efficiency of group models.

By keeping documents updated, tracking CAQH attestations, and working proactively with insurance credentialing services, ABA practices can ensure smoother enrollments, faster approvals, and reliable reimbursement. A well-managed credentialing process is not just about getting paid—it’s about building trust, stability, and longevity in your ABA therapy practice.