How to Get a Single Case Agreement Approved: Step-by-Step Guide for Therapists

What Is a Single Case Agreement in Health Insurance?

A single case agreement (SCA) is a one-time contract between an insurance company and an out-of-network provider. It lets the patient receive care at in-network rates, even though the therapist isn't part of that payer's network. In ABA therapy and behavioral health, SCAs are one of the most common ways to keep treatment going when insurance coverage gaps get in the way.

Here's what makes an SCA different from a standard payer contract:

• It covers only one patient for a specific service over a set time period, usually 6 to 12 months.

• It's a temporary fix, not a permanent network agreement, and both the reimbursement rate and session limits are negotiated case by case.

If you want a deeper breakdown of how SCAs work and when they apply, read our full guide on single case agreement basics.

Who Can Request a Single Case Agreement With Insurance?

Either the patient or the provider can start the process. In practice, providers handle most requests because they can supply the clinical justification directly.

Insurance companies typically approve an SCA when one of these conditions exists: there are no in-network providers within a reasonable distance, the patient needs a specialized service that in-network providers can't deliver, or switching therapists' mid-treatment would harm the patient's progress.

For a Medicaid single case agreement, the bar is higher. Most state managed care organizations want documented proof that you contacted two or three in-network providers who were unavailable or had full caseloads. Save those call logs because the insurer will ask.

Documents Needed for Insurance Single Case Agreement Approval

Incomplete paperwork is the number one reason SCA requests stall. Before you pick up the phone, gather these: a clinical justification letter explaining why this patient needs your services specifically, diagnosis documentation, your credentials and NPI number, proof of network inadequacy (names and dates of in-network providers you or the patient contacted who couldn't take the case), a proposed treatment plan with CPT codes and session frequency, and your requested reimbursement rate.

Some payers have a standard single case agreement form. Call provider relations and ask. Using their form instead of a freehand letter saves time because the reviewer doesn't have to search for the information they need.

If your payer enrollment is still in progress, say so in the request. Insurers are far more likely to approve an SCA when they can see you've already applied for ABA credentialing services with their network.

How Insurance Companies Evaluate SCA Requests

Once your request lands on a reviewer's desk, they check three things.

Medical necessity. Does the patient need treatment, and does your clinical documentation back it up?

Network adequacy. Are there truly no in-network options? If the insurer can point to an available provider within 30 miles, your SCA is probably getting denied.

Cost reasonableness. Is your proposed rate in the same range as what they pay in-network providers for the same CPT codes?

Build your request around these three criteria and you're already ahead of most submissions.

Common Reasons Single Case Agreements Get Denied

Denials almost always come down to one of these: the insurer found an available in-network provider you didn't mention, your documentation was missing key details, your requested rate was too far above the payer's fee schedule, or the patient's plan simply doesn't allow out-of-network exceptions (some self-funded employer plans fall here).

If you get a denial, request it in writing and ask for the exact reason. Then resubmit with stronger documentation that addresses the gap. Having a clear denial management process makes a real difference here, especially when you're handling multiple SCAs at once.

How to Speed Up the Single Case Agreement Approval Process

Most providers lose time by submitting and waiting. Here's what actually moves things along. Call the insurer before you submit to confirm they accept SCAs and get the correct fax number or portal link. Send every document in one packet so nothing gets separated. Follow up by phone within five business days and get a reference number. Call weekly after that. If progress stalls, ask for a supervisor or request an expedited review based on medical necessity.

Good follow-up habits help beyond just the SCA. Tracking submissions closely also keeps your accounts receivable in medical billing from aging out once claims start flowing.

SCA Approval Timeline in 2026

How long does it take to get a single case agreement? Most insurers process requests in 10 to 30 business days. Some approve within a week when the documentation is clean. Others stretch to 45 days, especially Medicaid managed care plans.

The timeline resets every time the insurer kicks back an incomplete submission. Getting every document right the first time can save you weeks.

What Happens After Your Single Case Agreement Is Approved

You'll receive a written agreement that lists the covered services, reimbursement rates, session limits, and start and end dates. Read every line. Confirm that the CPT codes match your treatment plan and the rates reflect what you negotiated.

Bill claims the same way you would for in-network patients but attach a copy of the signed SCA to your first submission. This stops the claims department from processing it as out-of-network by mistake.

Most SCAs last 6 to 12 months. Set a reminder 30 days before expiration so you can start the renewal process early. If juggling multiple SCAs on top of regular billing is pulling you away from patient care, working with outsourced ABA billing services can take that off your plate.

FAQs

What is a single case agreement in healthcare?

A single case agreement in healthcare is a temporary contract between an insurance company and an out-of-network provider. It allows one specific patient to receive treatment at in-network rates when no suitable in-network option is available. SCAs are common in ABA therapy, mental health, and specialized treatment settings.

How long does it take to get a single case agreement?

Most insurers take 10 to 30 business days to process an SCA request. Timelines vary by payer and plan type. Complete documentation and weekly follow-up calls are the two fastest ways to cut the wait.

Can you get a single case agreement with Medicaid?

Yes. Medicaid managed care plans approve single case agreements, though requirements are stricter. You'll usually need documented proof of network inadequacy, including records showing you contacted multiple in-network providers who couldn't take the patient.

Get Your SCA Approved Without the Back-and-Forth

The single case agreement approval process comes down to three things: the right documents, a clean submission, and consistent follow-up. Skip any one of those and you're adding weeks to the timeline.

If you'd rather spend that time on patient care, book a call with Pacemave and let us handle the insurance side.