We’d like to offer some guidance for our provider community about the appropriate prior authorization request submission practices for applied behavioral analysis (ABA) therapy services for our Harvard Pilgrim Health Care and Tufts Health Plan members.
When requesting prior authorization for ABA therapy services, it’s important to submit your request in the manner that best allows for the claim to match to the authorization in our system — and that methodology varies by line of business. We want our provider partners to have the best experience possible when doing business with us, so please keep the following product-line-specific guidance in mind for the quickest and most efficient claims processing.
Tufts Health Plan members
If you are requesting prior authorization for ABA therapy services for a member of a Tufts Health Plan product, please submit your request under the billing NPI of your practice (type 2) rather than under the NPI of the individual therapist.
Harvard Pilgrim members
When requesting authorization for a Harvard Pilgrim member, you’ll need to submit the request under the most appropriate NPI depending on your provider type to ensure a match in the claims system:
Additional reminder
Providers should additionally be aware that the Jan. 1, 2025 changes to MassHealth’s credentialing requirements — which we announced in the November 2024 issue of Insights and Updates for Providers — do not impact the way in which providers are expected to bill or request authorization for ABA therapy services. These updates have since been adopted across all Harvard Pilgrim and Tufts Health Plan products and reflect a process improvement designed to enhance program integrity and increase access to services. You should continue to request prior authorization for your Point32Health patients in a manner consistent with the guidance offered above.