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Referring Providers: Selecting the Correct Autism Care Demonstration/Applied Behavior Analysis Request Type

Thursday, April 28, 2022

Under TRICARE’s Autism Care Demonstration (ACD), TRICARE-authorized primary care managers (PCMs) or specialized autism spectrum disorder (ASD)-diagnosing providers must submit referrals for initial and ongoing applied behavior analysis (ABA) services. When submitting referral requests to Health Net Federal Services, LLC (HNFS), it is important to select the appropriate request type (also referred to as a request profile) when using our online submission tools. Request types are templates developed by HNFS in accordance with TRICARE manuals. After selecting a request type in the online submission tool, our system auto-populates the request with the associated approved codes and/or code ranges, number of visits and duration of the authorization. Please take a moment to review answers to referring providers’ frequently asked questions about request types specific to ABA services. 

Note: You can find lists of request types in our Online Referral/Authorization Submissions Request Type Guide. The guide lists ABA-related request types in the Outpatient Authorization Request Types section.

The following frequently asked questions apply to referring providers and not ABA providers.

As the referring provider, which request type should I use on the referral for initial or ongoing ABA services? 

Please use request type P174 for initial and ongoing ABA services, to include: 

  • Initial referrals for ABA services
  • Initial assessments for ABA services
  • Subsequent two-year referrals for ABA services

What happens if I select P1 for ABA services?

P1 is specific to evaluate and treat specialty referrals and does not apply to ABA services under the ACD. Using P1 may result in incorrect approval of an office visit, which is not a covered benefit for ABA, or the request will be canceled and require resubmission. 

Under the ACD, do approvals for office visits equal approval for ABA services?

No. Approval for ABA services is separate from approval for office visits. Office visits are not a covered benefit under the ACD.

Which request type should a referring provider use to request a new ABA provider or second opinion?

Referring providers should submit request type P174 – ACD ABA Initial Assessment Authorization for a new ABA provider or second opinion.

Is there a request type for uploading documents related to discharge and outcome measures?

Referring providers should use P175 – ACD Outcome Measure Authorization and P178 – ACD ABA Discharge Report Submission for uploading discharge and outcome measures documentation.

What are common referral errors that may result in a delay in care?

  • Selecting the incorrect specialty for the servicing provider. For example: If you have selected “Assistant Behavior Analysis ABA”; “Behavior Technician ABA”; or “Behavior Analyst – Master’s Level PHD, ABA,” but you have not selected ABA as the specialty. Note: HNFS will update the servicing provider to an Autism Corporate Service Provider or Sole ABA Supervisor prior to approval. 
  • Selecting P177 – ACD Treatment Authorization instead of P174 – ACD ABA Initial Assessment Authorization.

Note: ABA providers are the only providers who should use P177 – ACD Treatment Authorization. No other providers should use this request type.

For more information on request types refer to the Request Type Guide