These allowable disclosures include mandatory request from the Department of Human and Health Services and requests from the individual themselves. Some states mandate benefit coverage for applied behavioral analysis for treatment of autism spectrum disorders. endobj endobj It helps clinicians decide appropriate levels and types of services that are medically necessary for a patient. h�b```���"�@��(��������s�@{Cʄ�3a�)K[�8���8�&��������DG�f��!�+���L�TY�/�/Tr�a ���Pߜ��'U�/��,x�w�Z�~v&�c@���AXH3206 )^�w0��� � �z,� Refer to our COVID-19 Q&As for providers (PDF) for important information on ABA services during the crisis (the ABA-specific section is at the end of the document). 402 0 obj <>stream 387 0 obj Applied Behavioral Analysis (ABA) services include behavioral health treatment, psychological care, and therapeutic care of members diagnosed Autism Spectrum Disorder. When health insurance began to cover applied behavior analysis as a medically necessary treatment, billing codes specifically for applied behavior analysis (ABA) did not exist. 0 All fields are required. %PDF-1.5 %���� Each treatment request must include all nine (9) components listed below: 1. Phone number 1-866-830-0325 . endstream TERM Treatment Plan Documentation Resources . startxref • Direct ABA treatment rendered via telehealth must be synchronous in nature. • Payors used a variety of billing codes to pay ABA claims, which caused confusion and impacted claims data collection. In those states, the applicable mandate must be followed. %%EOF You will need to have all the necessary clinical information at the time you call in. Box 601340 . As you’re aware, treatment is critical since it can contribute to the patient’s readiness to change at risk behaviors. They can be reached 9:00am- 6:00pm EST Monday-Friday at 800.241.4057, Ext 796.2452. Once you receive authorization from Magellan, you conduct the initial assessment and develop the treatment plan. You should call into the ABA/Autism queue to request treatment no morethan30 days prior to the current approvals on file expiring. ... •Providers also should seek to request a stand alone code for Treatment Planning whenever possible. "�?����@��xؖ(��6SD���U $�K�10120����8����� � Standard member cost sharing and benefit plan terms apply. The plan should include: • measurable goals, • data related to progress within individual treatment goals, psychiatrist, psychologist, or other licensed physician experienced in autism treatment Request for Continued Services: Submit pages 1 – 7 The Board-Certified Behavioral Analyst (BCBA) rendering and/or supervising the autism services should complete this form. A treatment plan in which clinic-based services are requested must be individualized, based on the medical necessity of the member and must indicate: Specific, individualized rationale as to why services are being recommended to be h�bbd```b``�3@$��5 ���V`��d�"u��� ��̞f��٭`RL.� Free parent ABA training through Relias. REQUEST (name and ID are needed to ensure that both pages are for same individual)indicate . Treatment Request Guidelines guidelines, claims submission, denials and appeals and the tracking of each aspect of the cycle. Phone: 877-824-8376 . U.S. Food and Drug Administration (FDA) Behavioral therapy programs are not subject to regulation by the FDA. You request and obtain pre-authorization for additional services by completing the ABA Treatment Plan / Concurrent Review Template. h�b```b``�c`e`�ab@ !�(� g��3� {��� Note: All approval for treatment is based on meeting medical necessity for specific treatment 1) For the Initial Treatment Request (ITR) Submit: Completed Clinical Service Request Form (pages 1-5), Diagnostic Evaluation Report, Provider Baseline and Skills Assessment Instruments and Comprehensive Treatment Plan (additional information may be requested by a clinician once the case is reviewed) • Other ABA Designated codes = Face to Face 97156, 97158 Group Code 1:2-3 patients → ABA Group Adaptive Behavior Treatment • Direct ABA treatment implementation, by protocol per the prior authorized ABA Plan by qualified technician (RBT/BAT) •Technician must be under the supervision of a BCBA/BCaBA • Code is for paraprofessional work only Optum Behavioral Health will also reimburse providers for telephone calls to patients, as described below: Until April 30, 2020, Optum Behavioral Health will reimburse appropriate San Diego, CA 92108 . ABA is a flexible treatment: Can be adapted to meet the needs of each unique person <>stream To determine whether Autism-related treatment such as applied behavioral analysis (ABA) is covered, please call Cigna’s national scheduling line to request benefits or authorization. The ABA Medical Necessity Guide can help you with the coverage determination process. ABA and telehealth. ABA Treatment Request: Required Information for Precertification. endobj Applied Behavior Analysis Provider Treatment Report Guidelines: Initial Authorization Request The following is a guide to what is expected in the individual assessment treatment plan for members with Autistic Spectrum Disorder. The following are required for the initiation and continuation of ABA services: 1.
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