BTEC Behavioral Therapy, Inc.
The requirements for referrals and necessary documentation for prior authorization may vary across insurance companies. BTEC strongly recommends that families check with their individual carrier regarding coverage of ABA therapy.
TRICARE beneficiaries are required to have a diagnosis of Autism Spectrum Disorder (ASD). ASD diagnosing and referring providers include: TRICARE-authorized Physician-Primary Care Manager (P-PCM) or by a specialized ASD diagnosing provider. TRICARE authorized P-PCMs for the purposes of the diagnosis and referral include: TRICARE authorized family practice, internal medicine, and pediatric physicians. Authorized specialty ASD diagnosing providers include: TRICARE-authorized physicians board-certified or board-eligible in developmental-behavioral
pediatrics, neurodevelopmental pediatrics, child neurology, adult or child psychiatry, doctoral-level licensed clinical psychologists, or board certified doctors of nursing practice (DNP). *Diagnoses and referrals from Nurse Practitioners (NPs), Physician Assistants (PAs), or other providers not having the above qualifications are not accepted by TRICARE.
A referral for ABA services under the ACD is required prior to beginning services. A P-PCM or specialized ASD diagnosing provider should submit the referral for ABA services to:
· 866-323-7155 TRICARE EAST ABA Dept.
The referral for ABA services must contain documentation of the age of the child and year of the initial ASD diagnosis, documentation of any co-morbid psychiatric and medical disorders, and level of symptom severity (level of support required per DSM-5 criteria under ASD).If the initial diagnosis is made by a P-PCM, the P-PCM should also submit a referral for a specialized ASD diagnosing provider who must confirm the diagnosis of ASD within one year.
OTHER FL INSURANCE AND FL MEDICAID PLANS:
While requirements may vary by company, the following general guidelines apply:
· * Documentation confirming a diagnosis of ASD signed by an MD.
· * Documentation of any other mental health or medical diagnoses.
A prescription, signed by an MD (most insurers will not accept referrals signed by ARNPs or PAs), recommending ABA therapy for the treatment of Autism (F84.0) is generally accepted by most insurers. The following referral forms may also be downloaded and contain the required documentation:
PLEASE FAX ALL DOCUMENTATION TO
BTEC’s REFERRAL LINE AT 850-435-7704
BTEC Behavioral Therapy NPI: 1427495761