The information below applies only to coverage on or after January 1, 2013. Read about ABA Therapy coverage during 2012.
- The first step is to see a neurologist, pediatric neurologist, developmental pediatrician, psychiatrist, or doctorate-level psychologist for an Autism Spectrum Disorder (ASD) diagnostic assessment, comprehensive evaluation report, and recommended treatment(s). This provider must have expertise in using evidence-based tools to establish or confirm the diagnosis of autism and experience in developing treatment recommendations that consider the full range of autism treatments, of which ABA Therapy may be one component. If ABA Therapy is recommended from the assessment, a prescription for such services is required. It is important that you contact UMP Customer Service at 1-888-849-3681 for assistance, to ensure that the necessary information is included in this assessment, or 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 Which providers can I see for ABA Therapy?) for an ABA Therapy initial report that includes assessment; functional behavior analysis, if indicated; and the ABA Therapy treatment plan. This step does not require preauthorization by the plan and is eligible for coverage.
- Submit a request for preauthorization for the ABA Therapy services to the plan.
For providers: How to request preauthorization
Documentation necessary to request preauthorization
The following documentation must be submitted with the preauthorization request:
Clinical evaluation, which includes confirmation of an ASD diagnosis, and recommended treatment (Step 1, above).
Written clinical Order, Directive, or Prescription for ABA Therapy services from a clinician meeting the criteria in Step 1, above.
ABA Therapy initial report that includes assessment; functional behavior analysis, if indicated; and ABA Therapy treatment plan from a Lead Behavior Therapist meeting the criteria in Step 2, above.
ABA Therapy Preauthorization Request Form
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.