Prior Authorization for Applied Behavior Analysis ... - Provider Express

UnitedHealthcare Life Insurance Company and Golden Rule Insurance Company appreciate your participation in various clinical programs as we are alignin...

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Prior Authorization for Applied Behavior Analysis services for UnitedHealthcare Life Insurance Company and Golden Rule Insurance Company members

December 2015 Dear ABA Provider, UnitedHealthcare Life Insurance Company and Golden Rule Insurance Company appreciate your participation in various clinical programs as we are aligning our utilization management model to better support our commitment to quality, affordability and administrative simplification. Effective January 1, 2016, Optum will assume management of prior authorization and utilization review of Applied Behavior Analysis (ABA) services for members of UnitedHealthcare Life Insurance Company group number 755870 and Golden Rule Insurance Company group number 902667. As an Optum network provider, you may refer to the UnitedHealthOne Individual Plans Supplement in UnitedHealthcare’s Physician, Health Care Professional, Facility and Ancillary Provider Administrative Guide for your state for more information. ABA providers will be affected as follows: 

ABA Providers must complete the prior authorization process before scheduling or performing all ABA services.

ABA Providers must call to verify eligibility and benefits for ABA and then if the member has ABA benefits, ask to speak to the enhanced autism care management team. An autism-dedicated care advocate will return your call and walk you through next steps to complete the approval and prior authorization process. Note: These requirements do not apply to members of Golden Rule Insurance group number 705214. Please contact your Network Manager with any questions. For the Autism Network Manager contact information in your assigned region please go to the Autism/Applied Behavior Analysis Corner on Provider Express. Sincerely, Theresa Carter Director, Specialty Networks Optum

United Behavioral Health operating under the brand Optum BH430_12.16.15