All ABA providers must be certified. To become an ABA certified provider, complete this form and fax to (608) 221-7544. Once TRICARE-certified, providers remain certified as long as their licensure or board certifications are maintained.
All BCBAs must be credentialed if they choose to become a network provider. Apply to become a TRICARE network provider
Credentialing may take up to 30 days to complete. Providers must be re-credentialed every three years.
ABA providers are considered outpatient specialty providers. Authorized ABA supervisors and ACSPs are allowed to bill for ABA services.
All claims must be submitted electronically with Wisconsin Physicians Service (WPS) in order to receive payment for services. Claims can take up to 30 days to process. All claims for benefits must be filed no later than one year after the date the services were provided. Network providers can submit new claims and check the status of claims online using provider self-service.
In accordance with TOM Chapter 18 Section 4, prior authorization is required prior to rendering ABA services. Claims for services rendered without prior authorization will be denied.
Topics covered include TRICARE certification requirements, Humana Military credentialing requirements,
referrals and authorizations, claims requirements, forms and key provider resources.
The quickest, most efficient way to request ABA services is online through provider self-service. Providers may also fax referrals and supporting documentation to (877) 378-2316.