The following applies to all UMP plans.
The information below applies to coverage on or after January 1, 2013.
- The first step is to see one of the following provider types for an Autism Spectrum Disorder (ASD) diagnostic assessment, comprehensive evaluation report, and recommended treatment(s).
- pediatric neurologist
- developmental pediatrician
- doctorate level psychologist
This provider must have experience using evidence-based tools to establish or confirm the diagnosis of autism. The provider must also have experience developing treatment recommendations that consider the full range of autism treatments, of which ABA Therapy may be one component.
If the provider's assessment recommends ABA Therapy, you need a prescription for these services. It is important that you contact UMP Customer Service at 1-888-849-3681 for assistance, to make sure the necessary information is included in this assessment. Otherwise, your preauthorization request might be delayed for additional information. This step does not require preauthorization by the plan and is eligible for coverage.
- If ABA Therapy is prescribed, the next step is to see a Lead Behavioral Therapist (see Finding providers for ABA Therapy) for an ABA Therapy initial report that includes assessment, functional behavior analysis, and the ABA Therapy treatment plan. This step does not require preauthorization by the plan and is eligible for coverage.
- Providers should submit a request for preauthorization for the ABA Therapy services to the plan. Providers may contact UMP Customer Service at 1-888-849-3681 for assistance.
Documentation necessary to request preauthorization
The initial preauthorization request must include the following documentation:
- ABA Therapy Preauthorization Request Form (to be completed by the Lead Behavioral Therapist).
- Clinical evaluation, which includes confirmation of an ASD diagnosis, and recommended treatment approach from a clinician meeting the criteria in Step 2, above.
- Written Clinical Order, Directive, or Prescription for ABA Therapy services from a clinician meeting the criteria above.
- ABA Therapy initial report that includes assessment and ABA Assessment and Treatment Plan Form* (to be completed by the Lead Behavioral Therapist).
Concurrent Review: What should I do if my current authorization is expiring?
Within five business days before the end of a current authorization, the Lead Behavioral Therapist should submit the following documents:
After the Lead Behavioral Therapist submits the information above, the plan may request that the provider (in #1 above) prepare and submit more information. The plan will explain what must be included in this report, which is intended to measure progress and prospective treatment in more detail. The report may include a written Clinical Order, Directive, or Prescription for ABA Therapy services.
If you or your provider has any questions about how to submit a preauthorization request for ABA Therapy, or what needs to be included, please call UMP Customer Service at 1-888-849-3681.
*The Lead Behavioral Therapist should contact UMP Customer Service at 1-888-849-3681 for a copy of the ABA Assessment and Treatment Plan Form. Please contact your Lead Behavioral Therapist if you have questions about this form.