Clinician guide
Submit an ABA Authorization During a Payer Portal Outage
Use an approved fallback route during an ABA payer portal outage while preserving deadlines, PHI, packet integrity, receipt, status and duplicate controls.
Clinician Resources
Clinical guides, tools, and evidence-informed resources for thoughtful, high-quality ABA care.
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Clinician guide
Request ABA Continuity of Care During a Network Transition
Request ABA continuity of care during a network transition with event evidence, current treatment, member choice, provider terms, authorization, cost and exit plan.
Clinician guide
Coordinate ABA Authorization Across Primary and Secondary Coverage
Coordinate ABA authorization across primary and secondary coverage by keeping each plan's benefit, network, prior auth, claims, remittance and appeals separate.
Clinician guide
Request Out-of-Network or Single-Case ABA Authorization
Request out-of-network or single-case ABA authorization using network search, access need, provider terms, evidence, cost, dates, continuity and claim setup.
Clinician guide
Identify Plan, TPA, and Delegated UM Roles in ABA Authorization
Identify plan, TPA and delegated ABA utilization-management roles for benefits, networks, prior auth, portals, notices, appeals, claims, payment and privacy.
Clinician guide
Route ABA Authorization Through the TRICARE Autism Care Demonstration
Route ABA authorization through the TRICARE Autism Care Demonstration using current national and regional sources for referral, assessment, review and treatment.
Clinician guide
Route ABA Authorization Through Medicaid Managed Care
Route ABA authorization through Medicaid managed care by separating state, MCO or other entity, network, enrollment, prior auth, out-of-network and appeal duties.
Clinician guide
Route ABA Authorization Through Medicaid Fee-for-Service
Route ABA authorization through Medicaid FFS by verifying state authority, eligibility, enrollment, referral, form, portal, evidence, dates, units and appeal.
Clinician guide
Route ABA Authorization for a Marketplace Qualified Health Plan
Route ABA authorization for a Marketplace QHP by verifying issuer, product, enrollment, service area, network, benefit, prior-auth process, dates and appeal path.
Clinician guide
Route ABA Authorization for a Self-Funded Employer Plan
Route ABA authorization for a self-funded employer plan by separating the plan sponsor, administrator, TPA, network, UM vendor, governing documents and appeals.
Clinician guide
Route ABA Authorization for a Fully Insured Commercial Plan
Route ABA authorization for a fully insured plan by identifying the issuer, product, network, benefit, delegated reviewer, plan documents, appeal and claim path.
Clinician guide
Request Concurrent ABA Services Without Double Counting
Request concurrent ABA services by mapping each participant, provider, purpose, exact interval, payer rule, documentation and unit without double counting.
