Back to Insights and Updates for ProvidersApril 2024

Standard form for Applied Behavior Analysis prior authorization requests

Harvard Pilgrim Health Care Commercial  |  Tufts Health Direct  |  Tufts Health Plan Commercial

If you provide Applied Behavior Analysis (ABA) services to Harvard Pilgrim Health Care Commercial, Tufts Health Plan Commercial, or Tufts Health Direct members, please be aware that in keeping with a recent Massachusetts mandate, a standard form for requesting prior authorization for ABA services has been adopted. The form, which was developed collaboratively by state provider groups, associations, and insurance carriers, is available now and is mandated for use by April 15, 2024.

We’ve updated Point32Health’s Applied Behavioral Analysis Therapy and Habilitative Services for Autism Spectrum Disorders Medical Necessity Guidelines to direct providers to the new Massachusetts Standard Form For Applied Behavior Analysis Services Prior Authorization Requests*.

We encourage providers to submit prior authorization requests electronically, in which case the prior authorization form must be uploaded with the request. If, however, you prefer to submit a prior authorization request by fax, please complete the form and fax it to the appropriate number below.

  • Harvard Pilgrim Health Care Commercial members: 800-232-0816
  • Tufts Health Plan Commercial members: 617-673-0314
  • Tufts Health Direct members: 888-977-0776

To request ABA prior authorization for Tufts Health Together members, continue using the Autism Spectrum Disorder Services Prior Authorization Form.

*While this form was developed for Massachusetts, providers in other states may also utilize this new standard form to submit ABA prior authorization requests for Harvard Pilgrim Health Care Commercial and Tufts Health Plan Commercial members.

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