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Covers prior approval requirements, eligibility based on updated DSM-5 Autism Spectrum Disorder diagnosis, assessment timing expectations, and examples of standardized functional assessments. Explains comprehensive assessment components and authorization decisions when members lack a comprehensive assessment, guidance on requesting developmental history and education assessments, and documentation rules for IEP requests and session notes including required daily note elements and signature requirements.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/aba-autismapplied-behavior-analysis-frequently-asked-questions/316431/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/aba-autismapplied-behavior-analysis-frequently-asked-questions/316431.png","ImageObject",300,407,{"name":92,"@type":93},"Fez","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-22","2026-09-20",true,{"@type":102,"interactionType":103,"userInteractionCount":52},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"How do I request ABA services?","Question",{"text":112,"@type":113},"All services require prior approval. Verify benefits/eligibility online or call the Behavioral Health number on the Member’s ID card, and request assessments online or via the ABA-dedicated clinical team and approved submission methods.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"What diagnosis is needed for eligibility for ABA services?",{"text":117,"@type":113},"Members need an updated DSM-5 diagnosis of Autism Spectrum Disorder to be eligible for ABA services unless state-specific mandates allow different diagnoses. The acceptable diagnosis must be confirmed by benefits or the clinical team when authorizing.",{"name":119,"@type":110,"acceptedAnswer":120},"How often is an ABA assessment required?",{"text":121,"@type":113},"There is no required frequency for assessments. At a minimum, most treatment reviews are required every 4-6 months depending on account and state law.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},316431,1790285004,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":52,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":145},2336478940794,"https://ap-avatar.wpscdn.com/davatar_9964176cb1d06d4a9deccf72a44ae3dc","FREQUENTLY ASKED QUESTIONS  \nAutism/Applied Behavior Analysis Using HCPCS Codes  \nBoard Certified Behavior Analyst® , BCBA® , Board Certified Behavior Analyst-Doctoral™, BCBA-D™, Board Certified Assistant Behavior Analyst™, BCaBA® , Registered Behavior Technician™, RBT™ and BACB® are registered trademarks of the Behavior Analyst Certification Board, Inc. ® . All Rights Reserved.  \nCLINICAL  \nQ1 . How do I request any services for ABA?  \nA1 . All services require prior approval.  \n􀀹 Verify benefits/eligibility online at [providerexpress.com](providerexpress.com) or call the Behavioral Health number located on the back of the Member's ID card.  \n􀀹 Assessments can be requested online at:  \n[optumpeeraccess.secure.force.com/ABAasses](optumpeeraccess.secure.force.com/ABAasses)  \nsment/  \n􀀹 Prior Authorization can be obtained by:  \n􀁸 Calling the ABA-dedicated clinical team at 1-866-830-0325, or  \n􀁸 Indiana providers only, faxing treatment plan to 1-888-541-6691, or  \n􀁸 Indiana, Ohio, Washington, Tennessee, New Mexico and Arizona providers only, submitting treatment plan online at  \n[optumpeeraccess.secure.force.com/ABAtreat](optumpeeraccess.secure.force.com/ABAtreat)  \nment/  \n􀀹 Authorization status can be viewed [online at](online at providerexpress.com)[ providerexpress.com](online at providerexpress.com)  \nQ2 . What if the member has a DX of Asperger’s, PDD-NOS underICD-10/DSM-IV?  \nA2 . Members need to have an updated DSM-5 diagnosis of Autism Spectrum Disorder to be eligible for ABA services unless state-specific mandates allow different diagnoses.  \nAcceptable diagnosis would need to be confirmed by benefits or the clinical team when authorizing.  \nQ3 . How often is an ABA assessment required?  \nA3 . There is no required frequency at which an assessment must take place. At a minimum,  \nmost treatment reviews are required every 4-6 months depending on the account/state law.  \nQ4. What are examples of standardized functional assessments?  \nA4 . Examples include: Verbal Behavior Milestone Assessment and Placement Program (VB-MAPP), Assessment of Basic Learning and Language Skills (ABLLS), and Vineland Adaptive Behavior Scale.  \nQ5 . Documented Comprehensive Assessment-In the Optum Supplemental  \nClinical Criteria: Applied Behavior Analysis there is a requirement for a Comprehensive Assessment to be present. How doABA providers ensure all components are present as they do not complete the assessments?  \nA5 . The diagnostic evaluation must be comprehensive and include the 10 categories in order to fully determine the strengths and needs of a member. Updated evaluations may target specific skill deficits and are not required tobe comprehensive, unless there is a question about an individual’s autism spectrum disorder diagnosis  \nQ6 . Can an ABA provider create a standardized form for the diagnosing individual  \nto fill out to ensure required components of the Comprehensive Assessment are present?  \nA6 . Yes, your agency can create a checklist to track components of the assessment.  \nQ7 . Optum’sABA Policy was updated in January 2018. How do we handle  \nexisting members who do not have a comprehensive assessment?  \nA7 . We would recommend that the family work towards getting a comprehensive diagnostic assessment while continuing with services in order to ensure that all of the patient’s needs are identified and necessary services are put in place. While we will not typically require this assessment for patients receiving treatment prior to January 2018, if we identify clinical concerns regarding a patient’s diagnosis, we may request the comprehensive assessment to occur as part of the next clinical review.  \nQ8 . What is a complete developmental history and education assessment?  \nA8 . This would likely be included in the comprehensive diagnostic assessment  \nQ9 . What if a family is unwilling to share a copy of the child’s Individualized  \nEducation Plan (IEP) and/or the school is unwilling to coordinate services?  \nA9 . Document th","cbCaidI073LG5nCs","https://ap.wps.com/l/cbCaidI073LG5nCs","pdf",175984,11,"English","# Clinical\n## Requesting services and approvals\n## Diagnosis eligibility and assessment frequency\n## Standardized and comprehensive assessments\n## Documentation requirements and session notes","[{\"question\":\"How do I request ABA services?\",\"answer\":\"All services require prior approval. Verify benefits/eligibility online or call the Behavioral Health number on the Member’s ID card, and request assessments online or via the ABA-dedicated clinical team and approved submission methods.\"},{\"question\":\"What diagnosis is needed for eligibility for ABA services?\",\"answer\":\"Members need an updated DSM-5 diagnosis of Autism Spectrum Disorder to be eligible for ABA services unless state-specific mandates allow different diagnoses. The acceptable diagnosis must be confirmed by benefits or the clinical team when authorizing.\"},{\"question\":\"How often is an ABA assessment required?\",\"answer\":\"There is no required frequency for assessments. At a minimum, most treatment reviews are required every 4-6 months depending on account and state law.\"}]","ABA Autism/Applied Behavior Analysis - Frequently Asked Questions | PDF",1789916974,28]