Humana Military’s licensed clinical reviewers (Board Certified Behavior Analysts (BCBA) and Board Certified Behavior Analysts-Doctoral (BCBA-D)) perform clinical necessity reviews on all treatment plans prior to authorizing treatment. Clinical necessity refers to services that are appropriate to address the diagnosed condition. For Applied Behavior Analysis (ABA) services this means addressing Autism Spectrum Disorder (ASD) symptoms.
Once Humana Military has received a complete treatment authorization request from the ABA provider, the clinical review process will begin.
The clinical reviewer may request additional information needed to determine clinical necessity. If the additional information is not provided in a timely manner, this could potentially cause a gap in services.
Once the review is complete, the reviewer will authorize clinically necessary and appropriate treatment or request the provider submit an updated treatment plan for further review. In the event the provider is requested to submit an updated treatment plan, the clinical review process restarts when all information is received.