ABA Prior Authorization Requirements – Initial PA – United Healthcare

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  • This insurance company requires prior authorization for ABA therapy. Here are the details to help your clinic complete the prior authorization process.
  • Prior Authorization Requirements

  • Step 1 = Get 97151 Initial Assessment pre-authorized.
    You have to get the 97151 Initial Assessment pre-authorized first.
    Do an assessment request online. www.providerexpress.com
    United States
    (Don’t log in.)
    Autism/ABA Corner
    Click on Autism/ABA Information.
    Click on Online ABA Assessment Requests.

    Fill this out. (You need to put down the number of units you are requesting for the 97151 and which date you want to have it.)
    Also you will need to upload the comprehensive diagnostic evaluation as part of this online assessment request.
    Click Submit.
    The screen will then let you know that you completed the submission correctly.
    Within 3-10 days, Optum will send a fax to the clinic letting you know if they approve the assessment.
    Then you can schedule the assessment with the patient.
  • Step 2 = Get ongoing care pre-authorized.
    After you have had the 97151 assessment appointment, you need to call the Optum Prior Auth department to go over all the care that you are requesting for this patient. You will speak with a care advocate and request all the needed units for all needed codes. When you are on the phone with the care advocate, they will let you know how much care they approve for this child. The phone # to call for this is: 866-830-0325 Opt. 2, Opt. 6 = Direct Line to Pre-auth department.
    Once Step 2 is completed and Optum has let you know how much care they approve, you can begin treating the patient for the ongoing ABA therapy.
  • When you receive prior authorization approval from Optum for patient’s ABA therapy, please upload the prior authorization approval letters to us in Teamwork.
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