To enroll in the ACD and obtain ABA services, beneficiaries need a:
For a list of approved TRICARE ASD-diagnosing providers, review TOM Ch. 18 Sec. 3 paragraph 11.13.
Registered providers should use provider self-service to submit all referrals and authorization requests.
Providers who do not have a provider self-service account should register for an account to submit referral and authorization requests online.
Humana Military will authorize an initial assessment for outcome measures for Treatment Plan (TP) development upon receipt of all necessary documents. Failure to provide necessary clinical information may result in delays, terminations of authorized care and denials for pended claims.
During the initial assessment with an authorized ABA supervisor, target ASD symptoms are identified, and a TP is developed.
After the initial assessment is complete, ABA supervisors must submit a new authorization request containing:
If the ABA supervisor cannot complete the required outcome measures, please notify Humana Military at (866) 323-7155 to ensure completion of these outcome measures.
ABA services must be pre-authorized before services begin. Humana Military does not accept retrospective referrals and will not backdate late submissions. Providers can submit requests for ongoing treatment up to 60 days in advance. However, submitting requests less than 30 days before the current authorization expires may result in non-reimbursement for ABA services.
TPs are reviewed for clinical necessity every six months to allow reassessment and document progress in improving core deficits. Prior to the expiration of each six-month authorization period, the authorized ABA supervisor must submit a new request for re-authorization of ABA services for the next six months from Humana Military. Providers must submit updated TPs and required outcome measures for review.
Every two years, a valid referral from an approved ASD-diagnosing provider or specialist must be submitted with the ASD diagnosis, level of support and approved DHA DSM-5 checklist. A two-year referral may be accepted up to six months in advance of its respective due date.
Outcome measures timeline - what to expect the first two years