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Changing ABA Provider Specialties Triggers Credentialing Review

Tuesday, May 26, 2020

Health Net Federal Services, LLC (HNFS) would like to remind our applied behavior analysis (ABA) providers that changing specialties will require us to credential or re-credential you as a network provider. HNFS must conduct credentialing reviews on network providers to verify the minimum requirements of the Defense Health Agency, HNFS and URAC are met. Providers cannot render services or be reimbursed under a different specialty until approved by HNFS. Please allow us 60–90 days to complete the credentialing process.  

Specialty changes:

  • BCBA to BCBA-D
  • Loss of a higher level certification

As behavior technicians (BTs) are certified and not credentialed, BTs changing to any other ABA specialty will always trigger a credentialing review. 

Registered Behavior Technician™ (RBT), Board Certified Autism Technician (BCAT), ABA Technician (ABAT), Qualified Autism Services Practitioner (QASP), Board Certified Assistant Behavior Analyst® (BCaBA), Board Certified Behavior Analyst® (BCBA), BCBA-doctoral (BCBA-D), Licensed Behavior Analyst (LBA)

How to update your specialty with HNFS

  1. Submit an updated roster for the providers whose specialty has changed. This roster only needs to includes those providers who have a new specialty. Find this form and submission details on our Forms page.
  2. Authorize HNFS to view your CAQH® record. Visit www.caqh.org to make sure your profile permits global access or grants HNFS access. TRICARE West Region network providers are required to complete a CAQH online application (and keep their information current), except those located in Idaho, Hawaii, Minnesota, and Washington, as an alternate to CAQH is available.

  3. Allow HNFS 60–90 days to complete the credentialing review. If we need additional information, we will reach out via email to the credentialing point of contact listed in CAQH (or equivalent). If none indicated, we will use the personal email listed. 

  4. Wait to render services at the higher level until approved by HNFS. We email approval letters to the credentialing point of contact. HNFS cannot reimburse at a higher level unless the provider has been approved for that level. Similarly, services may not be rendered at a higher level for Current Procedural Terminology® (CPT) codes where there is a minimum specialty required (such as CPT 97155, 97156, 97151). Submission of claims for these codes may result in an additional claims audit by HNFS.  You can check credentialing status online.

Questions? We offer ABA-specific FAQs online. You may also contact our Autism Care Demonstration (ACD) Customer Service team at 1-844-866-WEST (1-844-866-9378), option 1, then option 5 after the prompts. Please allow 45 business days before calling about credentialing status.  

Thank you for your continued partnership in caring for military service members, retirees and their families, and for providing TRICARE beneficiaries the best care possible during the COVID-19 pandemic. For TRICARE updates related to COVID-19, visit our COVID-19 resources page and www.health.mil/coronavirus