In the October 2025 issue of Insights and Updates for Providers, we offered guidance on how providers should request prior authorization for applied behavioral analysis (ABA) therapy services for Harvard Pilgrim Health Care and Tufts Health Plan members in order for the claim to match appropriately to the authorization in our system.
We have since adjusted our system to allow for greater consistency across product lines, and the result is a more streamlined submission process for authorization requests.
Requesting authorization for ABA therapy services
When requesting prior authorization for ABA therapy services for any Point32Health member, you should submit the request under the billing NPI of your practice (type 2) rather than under the NPI of the individual therapist.
This applies regardless of whether the member has a Harvard Pilgrim or Tufts Health Plan product, and whether you are submitting the request as a provider group or on behalf of a clinic, etc. We anticipate that this system update will deliver an improved and simplified provider experience resulting in more efficient claims processing.
Accreditation requirements: reminder and update
In addition, as we highlighted previously, Point32Health is implementing a new requirement that all contracted ABA providers must obtain accreditation from a nationally recognized accrediting body specializing in ABA. The requirement supports a MassHealth initiative aimed at strengthening program integrity and improving access to services, and Point32Health expanded the scope to include all Harvard Pilgrim and Tufts Health Plan products across every state in our service area.
At the time of our original communication about this change, Point32Health had aligned accreditation deadlines with MassHealth across all states, with center-based ABA providers requiring accreditation by Jan. 1, 2027 and all other ABA providers (including new providers) requiring accreditation as of Jan. 1, 2028. We have since reevaluated our approach to better support successful implementation, and have consequently extended the accreditation deadline for center-based ABAs in New Hampshire, Maine, and Vermont.
The new requirements are as follows:
As a reminder, these new accreditation requirements do not impact the way in which providers are expected to bill or request authorization for ABA therapy services. You should continue to request prior authorization for your Point32Health patients in a manner consistent with the guidance offered above.