Posted April 28, 2021
As of March 2021, we’ve updated our ABA request forms to help streamline data required for review of services for commercial non-HMO members. The updated documents are available on our Forms page, in the Behavioral Health (Commercial) category.*
To request services:
- Download, complete and print out the appropriate form (Initial Assessment Request or Clinical Service Request for initial and concurrent treatment requests).
- Be sure to include the contact information and signature of the rendering Qualified Healthcare Provider (QHP) who is providing treatment.
- Fax the completed form to us at 1-877-361-7656 at least two weeks before the requested start date.
This form must be received within 30 days of the start date of your assessment with the member. After that date, claims should be submitted through your normal process and you will receive instructions on how to proceed.
Questions? Call our Behavioral Health Unit at 1-800-851-7498.
*This article doesn’t pertain to ABA service requests for our HMO members.