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Understanding Autism Care Demonstration Additional Information Requests

Tuesday, April 30, 2024

When you submit well organized authorization requests that meet TRICARE’s Autism Care Demonstration requirements, you help Health Net Federal Services, LLC (HNFS) make coverage determinations more quickly. HNFS will pend any incomplete requests we receive and fax the applied behavior analysis (ABA) provider an additional information request (AIR) letter. Your timely response to AIRs can help beneficiaries avoid delays in treatment.

What happens when I receive an AIR?

You will have up to 10 business days to submit requested information. Please read the letter carefully, as it  provides a detailed explanation of what modifications you must make to a treatment plan or what documentation you must provide to fulfill missing requirements. Once we receive requested information fulfilling all requirements,  we will complete our clinical necessity review within five business days to make a coverage determination.

What happens if I miss the 10-day deadline?

If we do not receive your requested information within 10 business days, we will cancel your request. Once we receive the information, we will continue the clinical necessity review.

How do I submit an updated treatment plan or missing documentation?

You will need to submit a new authorization request using CareAffiliate® and attached the updated documents. Log in at
www.tricare-west.com and click on “Submit an Authorization” in the Secure Tools box. Important: The clinical necessity review timeline will restart each time HNFS needs to request additional information. We will not issue  backdated or retro authorizations under any circumstances.

Did you know? You also can use HNFS’ online tools to check authorization status, submit a claim and check claim status, use secure messaging, and more? Visit our Provider page to learn more about available self-service tools.