After the initial assessment, your applied behavior analysis (ABA) provider will submit a request for treatment (ABA services) authorization to Health Net Federal Services, LLC (HNFS).
HNFS will first verify the following elements are in place:
- TRICARE eligibility
- ACD eligibility
- Treatment plan with parent goals/engagement
- Parent PDDBI scores
- Outcome measures (required before HNFS can authorize treatment)
- Individualized Education Program (IEP), when applicable
Once our verification is complete, we will start the clinical review process. Visit our Clinical Necessity Review page to explore what happens during these reviews.
Part of the clinical necessity review process involves reviewing the ABA service settings for appropriateness. Learn more about locations approved for services through the ACD by visiting our Service Settings page.
Note: ABA providers may not render any services prior to the treatment authorization being approved.
Treatment Authorization Approvals
ABA treatment authorizations are approved in six-month increments. ABA providers will not be reimbursed for services rendered prior to the treatment authorization being approved.
- Providers and beneficiaries can view copies of treatment authorization determination letters online from their secure inbox.
- Submitting a request to HNFS is not a confirmation of authorization.
- HNFS will deny reimbursement for services performed outside the dates approved on the authorization.
- HNFS does not issue backdated authorizations. If an authorization is canceled due to missing supporting documentation, the authorization will be re-issued from the date HNFS receives all required information.