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ABA Provider Update: Roster Submissions/Behavior Technician Effective Dates

Friday, February 7, 2020

In response to your feedback, we are simplifying the way to submit applied behavior analysis (ABA) provider data to us. Additionally, we are asking behavior technicians (BTs) to no longer use our online Check Credentialing Status tool, as the results may not be accurate. We will be removing BT data from this tool in the coming months. Please read below and browse our website for details. 

We’ve expanded the role of our dedicated Autism Care Demonstration (ACD) customer service line.
Contact HNFS’ Autism Care Demonstration (ACD) Customer Service team at 1-844-866-WEST (1-844-866-9378), option 1, then option 5 (after the prompts) if you need to:

  • Verify network effective dates (example, “Why is my BT not showing in the XpressClaim system?”).
  • Ask about the credentialing/certification process. (Please allow 45 business days before asking about status). 
  • Get information about TRICARE’s ACD program, including benefit, referral and authorization guidelines.

Have questions about how a claim processed? Call our Claims Department at 1-844-866-WEST (1-844-866-9378), option 1, then option 1 (after the prompts). 

On Feb. 10, 2020, we’re changing how ABA providers notify us of roster, demographic and specialty updates.
Beginning Feb. 10, ABA providers are to use the Update Demographics tool or TRICARE Provider Group Roster when requesting roster, demographic and specialty updates. We will no longer require/accept individual Provider Information Forms (PIFs) from ABA providers. Instead, please follow the process below when submitting provider information:

  • ABA providers already credentialed by HNFS (does not include BTs)
    • BCBA-Ds and BCBAs: Use the Update Demographics tool to submit updates.
    • Other ABA provider types and BCBA-Ds/BCBAs not yet registered on our website: Email us a completed TRICARE Provider Group Roster regardless of the size of your group or how many provider updates you are submitting.
      • Our group roster submission email has changed! Visit our Provider Forms page for this form and submission details. 
  • All BTs (new and existing)/ABA providers not yet certified/credentialed by HNFS
    • Email us a completed TRICARE Provider Group Roster regardless of the size of your group or how many provider updates you are submitting.  
    • While not credentialed by HNFS, BTs must go through a national or state (if offered) certification process and be approved by HNFS to render care to TRICARE West Region beneficiaries.

We’re also implementing a new certification process for behavior technicians.

  1. Beginning Feb. 10, 2020, we will use the BT’s national or state certification date as his/her effective date with HNFS, as long as the group has an executed network agreement by that date. Be sure to complete the “License Issue Date” on the TRICARE Group Roster template with this required information.  

    History of BT effective dates loaded in HNFS systems:

    – Prior to May 13, 2019: Date group roster was submitted to HNFS
    – May 13, 2019–Feb. 9, 2020: Date BT was approved by HNFS' credentialing committee
    – As of Feb. 10, 2020: BT's national certification date

  2. Behavior technicians who have an active national or state certification may begin seeing patients as of their certification date submitted on the group roster. Please ensure your BTs have met all certification requirements as of the date you provide to us. We cannot approve or pay claims for BTs who do not meet requirements. 

  3. It can take HNFS up to 45 business days to process and load rosters once received. We recommend you wait 45 business days after submission of a roster to submit claims to avoid unexpected denials. 

  4. If you submit claims electronically using XPressClaim®, the affiliation date listed for specific BTs is not an effective date. Please do not refer to this date for claims billing purposes. If after 45 business days from submitting your roster you experience claims issues due to BT effective dates, contact us for assistance (see above). 

We offer detailed information for ABA providers at our Applied Behavior Analysis benefit page, including column-by-column instructions on how to complete the Group Roster Template.