As we await further guidance from DHA on the January 1, 2019 release of ABA CPT codes, please note that any change in codes will not require a new authorization and does not change any previously approved care. Frequently Asked Questions
There has been a change to the law regulating ABA providers in the state of Texas effective September 1, 2018.Learn more
“There has been a change to the law regulating Applied Behavior Analytic providers in the state of Texas effective September 1, 2018. Behavior analysts and assistant behavior analysts must be licensed by the Texas Department of Licensing and Regulation in order to participate in the ACD and provide services under that demonstration. For more detailed information regarding the changes to this law please refer to this website."
“There has been a change to the law regulating Applied Behavior Analytic providers in the state of Texas effective September 1, 2018. This change will specifically affect assistant behavior analysts with the designation of Qualified Autism Services Practitioner (QASP) or Qualified Autism Services Practitioner-Supervisor (QASP-S). Behavior analysts and assistant behavior analysts must be licensed by the Texas Department of Licensing and Regulation in order to participate in the ACD and provide services under that demonstration. The QASP/QASP-s will no longer be eligible for Texas licensure and as a result will not be eligible to participate in the TRICARE ACD as an assistant behavior analyst. Therefore, these providers will no longer be able to provide supervision to ABA recipients nor receive TRICARE reimbursement at the “assistant behavior analyst” level. However, they may continue to practice ABA services at the level of a “behavior technician” providing they meet the requirements outlined in the TRICARE Operations Manual Chapter 18, Section 4, Paragraph 6.3 and comply with applicable state legislation. For more detailed information regarding the changes to this law please refer to this website."
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.