Step one: Initial referrals are provided by the ASD diagnosing provider. If the initial diagnosis is made by a Physician-Primary Care Manager (P-PCM), the P-PCM must also submit a referral for a specialized ASD diagnosing provider who must confirm the diagnosis within one year. The specialized ASD provider must also complete the Vineland-3 and SRS-2 outcome measures within the first year of the initial diagnosis.
Step two: Upon receipt of the referral, Humana Military authorizes an initial ABA evaluation/assessment, treatment plan development and PDDBI outcome measure. At an initial evaluation with the authorized ABA supervisor, target symptoms are identified and a treatment plan is developed.
Step three: Once the initial evaluation/assessment, treatment plan and PDDBI (parent form) are submitted, Humana Military will authorize six months of ABA services based on the referral request and there is a TRICARE-authorized ABA supervisor with an opening to accept the beneficiary.
Step four: Treatment plans are reviewed for medical necessity twice annually to allow re-assessment and document progress in improving core deficits. Prior to the expiration of each six month authorization period, the authorized ABA supervisor or ACSP must request re-authorization of ABA services for the next six months from Humana Military (up to 60 days in advance). Providers must submit reassessments, updated treatment plans and PDDBI outcome measures for re-authorization.
Step five: Every two years from the initial authorization, a new referral for ABA services and a new referral for outcome measures from the PCM or specialized ASD diagnosing provider is required.
Providers have two options for submitting referrals for ABA services: online or by fax. The preferred method is online using provider self-service. Submitting online takes less time for providers, allows a way to check referral status, make updates when needed and offers the fastest processing.
The referral request tool can be accessed by logging into your Humana Military self-service account. If you don't have an account, you can register now
Providers who already have a self-service account can log in to create a referral request. If you need assistance submitting a referral, a tutorial is available once logged in to self-service. Log in
Providers have the option to fax in referrals, along with supporting documentation to (877) 378-2316. Please note that failure to provide necessary clinical information may result in delays, terminations of authorized care and denials for pended claims. Download the referral for ABA form
These resources are provided as a guide and courtesy only. Authorized ABA providers are not required to use them.