Applied behavior analysis (ABA) resources

You’ll find all the credentialing forms and information you need on our Join our Network page. Note: Licensed agencies wanting to join our network need to complete an organization/facility credentialing/re-credentialing application and W-9 . Please email us your completed documents.

Providers must complete a re-credentialing packet every 3 years. If this isn’t submitted in a timely manner, it puts the contract at risk for termination.

You’ll receive a letter as soon as your application is approved. Your acceptance is based on complete application information and meeting the network requirements. The credentialing process may take up to 90 days to complete.

Note: If it has been over 90 days from the date you submitted your application through ProviderSource, you can contact us by email.

For credentialing, licensed assistant behavior analysts (LABAs) do not need to get credentialed through LifeWise. Their services are billed under the credentialed, supervising licensed behavior analyst’s (LBA’s) name.

Both Microsoft and Amazon follow the same standard process and fee schedule rates.

During supervision, only LBAs can be billed for their time. Certified behavior technicians’ (CBTs) supervising time isn’t a covered service since the supervision is being delivered by the program manager/lead behavioral therapist. (CBTs include therapy assistants, behavioral technicians, and paraprofessionals.)

However, when a program manager/lead behavioral therapist is supervising a CBT while they’re providing direct treatment services, both the supervision by the program manager/lead behavioral therapist and the direct treatment services by the CBT are covered services. Prep time is not covered. During supervision of direct treatment, both the LBA and the CBT need to create separate chart notes. For supervision that doesn’t occur during direct treatment, only a chart note by the LBA is necessary.

Sign in to use our claims and payments tool (requires a OneHealthPort login) to get claim status, detailed payment information, and to download your explanation of payments (EOPs).If you still have questions about your claim, call customer service at 877-342-5258, option 2.

In addition to ASD, ABA therapy also covers autism and pervasive developmental disorders. This includes:

• Autistic disorder
• Rett’s syndrome
• Asperger’s syndrome
• Other childhood disintegrative disorder
• Pervasive development disorder unspecified

A patient’s treatment plans, as a standard, should be updated every 6 months. A treatment plan should be kept on file in the office and doesn’t need to be sent to LifeWise unless requested for an audit or medical records request.

For general guidance about coverage criteria for ABA services, see our medical policy 3.01.510. In addition, many member benefit booklets provide specific coverage criteria for ABA services.

Sign in and use our eligibility & benefits tool to get benefit information. If you still have questions about member benefits, call customer service at 877-342-5258, option 2.

Some portion of the direct service provision (no specific time amount is specified) may take place in a school setting when behavioral or other difficulties that are manifestations of the individual’s autism spectrum disorder (ASD) are evident and problematic in a school setting. Direct service provision in a school setting must consist entirely of bona-fide ABA treatment activities; the ABA clinician can’t be used as a classroom aide for the patient, as a 1:1 teacher for the patient, or in any other capacity that is a function of and the responsibility of the school system.

Assisting the member with school work or functioning as a tutor isn’t covered, except when they have demonstrated a pattern of significant behavioral difficulties during school work. Provision of services that are part of an individualized educational plan (IEP) that should be provided by school personnel and other school-obligated services are also not covered.

An LABA can provide services as a program manager under the supervision of an LBA per the license requirement. The LABA’s services are billed under the supervising LBA’s name. The LBA’s time supervising the LABA isn’t reimbursable under the plan; only the time the LABA spends on covered program manager activities is billable.

Team meetings are only covered when they’re specifically for treatment plan development or revision or case review for one specific patient. Prep time including charting data or plotting graphs, as distinct from actual analysis of data, aren’t covered.

Direct service provision by telehealth modalities, including to parents or family members, isn’t medically necessary because there’s no credible scientific evidence that the provision of ABA by telehealth modalities is effective or safe. Therefore, direct service provision by telehealth modalities isn’t covered.

Supervision may be conducted entirely in person or may be a combination of in person and remote, but some portion of the supervision (no specific time amount is specified) should be conducted in person.

The following are considered unnecessary duplication of services and therefore not medically necessary in the provision of ABA services:

• More than one program manager/lead behavioral therapist for a member at any one time
• More than one provider group/clinic/agency/organization providing ABA services for a member at any one time
• More than one clinician (program managers/lead behavioral therapists, or CBTs, or program manager/lead behavioral therapist and CBT) providing direct ABA treatment services to the same member at the same time

Exception: Amazon and Microsoft allow 2 program managers at the same time.

As of 2019, CBTs can now provide group therapy as a covered service. However, CBTs can’t assist with occupational or speech therapy because it’s not in their legally-authorized scope of licensure. CBTs should receive weekly clinical supervision from the program manager/lead behavioral therapist as follows for each patient: Generally, 2 hours for every 10 hours of direct service provision, with a minimum of 2 hours weekly when direct service provision is 10 hours per week or less. This is a standard used by the Behavior Analyst Certification Board.

ABA services by a family member, live-in nanny, or au pair are not covered. ABA services by a provider functioning as a live-in nanny or au pair also aren’t covered. In addition, our plans only cover training for parents and guardians. Nannies and au pairs can’t be train in their place in parent training.