7.1 Guide to Alpaca's Payout System

Overview

Our commitment is to make sure insurance issues never become a barrier to starting, running, or growing your ABA practice.

We can usually predict how much insurance should pay for services. But for many reasons—denials, processing delays, missing paperwork, or even something as simple as a lost check—insurance payments can be delayed. Most of the time this isn’t malicious; it’s just the reality of working with multiple payers.

The problem is that your staff still expect to be paid every two weeks, whether or not insurance pays on time.

That’s why Alpaca guarantees to pay you the insurance-reimbursable portion of your payment every two weeks, no matter what insurance does. We take on the payment risk so you can focus on delivering services without worrying about cash flow.

Here is the schedule of our payout and payroll cycles.

Key Terms

Insurance Rate — The rate Alpaca negotiates directly with insurance.

Allowed Amount — The number of billable units multiplied by the insurance rate. This is the total amount that insurance says the service is worth.

Patient Responsibility — The portion of the allowed amount that the client (or their family) owes, based on their benefits (co-pays, co-insurance, deductibles).

Insurance Payment — The portion of the allowed amount that the insurance company pays directly.

Expected Patient Responsibility — Our estimate of what the patient will owe, based on the initial verification of benefits (VOB) process. It’s an estimate because the insurance company makes the final determination when the claim is adjudicated.

Alpaca Contracted Rate — The rate Alpaca agrees to pay your practice per unit for services rendered under our agreement.

How it Works

You might think the entire allowed amount is “insurance-reimbursable,” since Alpaca negotiates a rate per unit with insurance. But for commercial insurance, this is often not the case.

Most commercial insurance plans have cost-sharing, meaning the client owes a portion of the cost through co-pays, co-insurance, or deductibles.

The relationship looks like this:

Insurance Payment + Patient Responsibility = Allowed Amount

When services are delivered, Alpaca calculates the expected patient responsibility using information from the VOB call. This gives us an expected patient responsibility percentage:

Expected Patient Responsibility ÷ Allowed Amount = Expected Patient Responsibility %

Every two weeks, we pay your practice:

(1 - Expected Patient Responsibility %) × Alpaca Contracted Rate

This represents the insurance-reimbursable portion of the Alpaca rate.

Later, when the patient pays their portion, we send you the remainder of the payment.

What if Our Estimate is Wrong?

Sometimes our expected patient responsibility will be off—especially since ABA services are often handled as a carve-out with different rules depending on the payer.

Once the insurance company issues the final adjudication, we reconcile:

• If we underestimated patient responsibility (meaning we underpaid you), we pay you the difference in the next payout.

• If we overestimated patient responsibility (meaning we overpaid you), we subtract the difference from the next payout.

Once adjudication is final, we bill the patient for their portion.

Once an adjudication is final, we will bill a patient.

How Alpaca’s Guaranteed Payment Works

Step 1 — Service Delivered

A BCBA provides 10 units of service.

• Insurance rate per unit: $50

• Allowed amount: 10 × $50 = $500

• Expected patient responsibility (from VOB): $20 (4%)

• Expected insurance payment: $500 − $20 = $480

Step 2 — Alpaca’s Biweekly Payment

Alpaca pays your practice the insurance-reimbursable portion every two weeks, even if insurance hasn’t paid yet.

In this example:

Insurance portion = (1 − 4%) × $500 = 96% × $500 = $480

Payout: $480 to your practice at the next biweekly payout.

Step 3 — Patient Pays Their Share & Reconciliation

When the insurance company adjudicates the claim, we learn that the actual patient responsibility is $30, not $20.

That means insurance covers $470 instead of $480. Since Alpaca already paid you $480, we overpaid by $10, which will be subtracted from your next payout.

The patient then pays the $30 co-pay. Adding that to the $470 covered by insurance means you’ve now received the full $500 payment for the service.

Note Signing Deadline

Notes are only included in a payout cycle if they are signed before the cycle's deadline. Each payout period ends on Sunday, and the signing deadline is Sunday at 4:00 PM PST. - Notes signed on or before Sunday at 4:00 PM PST are included in that period's payout. - Notes signed after the deadline roll into the next payout cycle. This deadline applies regardless of when the service was delivered — what matters is when the note is signed. We recommend building a workflow that ensures notes are reviewed and signed well before Sunday afternoon to avoid delayed payouts to your staff.

Payment Schedule and Reporting

We pay practices out every two weeks. You can access Payout reporting in the “Finances” tab of Alpaca and choose the relevant payout cycle.

You will see three tables:

• Payouts Table - these are advanced payments (based on expected patient responsibility) for notes signed.

• Insurance Reconciliation - once a claim is finalized by insurance, we have an actual patient responsibility. Any differences caused by a different expected patient responsibility from actual patient responsibility are handled here.

• Patient Payments - once a patient pays their patient responsibility, you’ll see the payment there, as well as the claims that have been finalized