Single-case agreements should be simple one family, one provider, one temporary approval. But anyone who works in healthcare knows it rarely goes that smoothly. A small documentation mistake or a delay from insurance can stretch the approval process for weeks, leaving families frustrated and providers stuck waiting for revenue.
Most providers don’t struggle because they lack skills. They struggle because SCA rules change often, every insurance company handles requests differently, and the paperwork behind the scenes is more complicated than it looks. That’s why clinics slowly realize the value of having strong support in medical billing, credentialing, denial management, and RCM instead of trying to juggle everything alone.
Below are the most common mistakes providers make and how you can avoid them.
1. Submitting Incomplete Documentation
The biggest reason SCAs get delayed? Missing paperwork.
Insurance companies rarely say, “We need more info.”
They simply place the file on hold.
Common missing items include:
- Progress notes not attached
- Incorrect CPT codes
- No explanation of medical necessity
- Old evaluation reports
- Missing supervision plans for ABA services
That’s why many clinics turn to teams experienced in ABA billing service to manage the paperwork correctly the first time. Even a small oversight slows the entire process, and families feel it immediately.
2. Not Showing Proof of In-Network Limitations
Insurance will not approve an SCA unless the provider proves the family cannot be treated in-network. Many providers forget to include:
- A list of in-network providers contacted
- Wait time documentation
- Written confirmation of service limitations
- Notes explaining why the child needs a specific clinic
This missing proof leads to quick denials.
And once an SCA is denied, reopening the case becomes harder.
A well-organized team ensures every detail is backed with evidence before sending anything to insurance.
3. Weak Follow-Up With Insurance
This is where many providers lose revenue without even knowing it.
Insurance companies don’t prioritize pending SCAs unless someone follows up consistently. A delay of 48–72 hours can turn into a week, then two weeks, then a month.
Here’s where many clinics slip:
- Calling insurance only once a week
- Not confirming escalation levels
- Missing callbacks
- Waiting for insurance emails instead of initiating contact
A dedicated RCM or ABA Therapy Billing Service team tracks the status daily, escalates the case when needed, and ensures approvals move forward instead of getting stuck in someone’s inbox.
4. Not Anticipating Denials
Some providers assume an SCA is “easy approval.”
But insurance companies deny SCAs often for reasons like:
- “Services available in-network”
- “Insufficient clinical rationale”
- “Missing therapist qualifications”
- “Duplicate request”
A denial is not the real problem—not being ready for the appeal is.
A strong denial management strategy includes:
- Preparing a proper appeal letter
- Adding clinical justification
- Providing updated assessments
- Highlighting risk factors and regression concerns
This is where 95% of the difference between a struggling clinic and a confident clinic appears. Your team should already know the next step before the denial even arrives.
5. Letting the Family Handle Communication Alone
This is a mistake many clinics make unintentionally.
They tell the family, “You have to call the insurance and request an exception,” and that’s it.
But families:
- Don’t know what to ask
- Get overwhelmed
- Miss important details
- Say things insurers use to deny the request
A professional, supportive approach is always better.
The provider should guide the family, write exact scripts for them, and coordinate calls when possible. Families feel supported, and approvals happen faster.
6. Not Coordinating the SCA With Billing and RCM Teams
Some clinics complete the SCA request but forget to check:
- Allowed rates
- Backdating rules
- Visit limits
- Prior authorization requirements
- Whether claims need special claim notes
7. Treating SCA as a One-Time Task Instead of a Process
A single-case agreement is not “submit → wait → get approval.”
It’s a continuous process involving:
- Verification
- Documentation
- Communication
- Negotiation
- Approval
- Claims processing
- Payment monitoring
When clinics treat it as a single task, something always gets missed.
When they treat it like a system, approvals and payments run smoothly.
8. Not Understanding How a Single Case Agreement Actually Works
Some providers don’t fully understand how SCAs are evaluated and approved by insurance companies. This leads to avoidable delays and confusion.
Families qualify for a single case agreement
- No in-network provider is available
- Wait times exceed recommended clinical windows
- The patient needs specialized care
- Nearby providers do not offer the required service hours
When providers learn to present these points clearly, approvals happen much faster—and families get the help they need without unnecessary stress.
Final Thoughts
SCAs are not as complicated as they look—but they demand accuracy, follow-up, and clean communication. Most delays, denials, and payment issues happen because providers are forced to multitask clinical work, billing, and admin tasks all at once.
With strong support in credentialing, medical billing, ABA therapy billing service, denial management, documentation, and RCM, clinics avoid common mistakes and move families into care much faster.
