If you are using a MAC or Apple device to submit claims through the Provider Portal web application, you must use CHROME. Safari will cause errors in the web application submitting claims.
ABA providers are considered outpatient specialty providers. Authorized ABA supervisors and Autism Care Corporate Service Providers (ACSP) 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. 98% of claims must be paid within 30 days and 100% within 90 days. 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.Learn more
Providers should include the start and stop times on the individual claim lines when submitting claims, even when billing for multiple services rendered by the same rendering provider on the same day. These sessions must be separated out, even when the CPT code is the same. When the times are not submitted on the individual lines, claims processing is delayed as additional research is required to confirm the correct start and stop times and corresponding charges.
In accordance with the TRICARE Operations Manual (TOM), Chapter 18 Section 4, prior authorization is required prior to rendering ABA services. Claims for services rendered without prior authorization will be denied. All claims must be submitted by BCBA/BCBA-D for services covered under the Autism Care Demonstration (ACD).
The ACD adopted new Category I CPT codes. Specifically, the ACD has adopted 97157, 97158, 99366, and 99368. New codes are eligible to be used beginning August 1, 2021 when prior authorized. Please note that revisions to existing authorizations is not permitted.Learn more