ABA Prior Authorization Requirements – Initial PA Today's Date* MM slash DD slash YYYY Patient Name* First Last HiddenPhone*HiddenEmail* Clinic*Choose a ClinicDreamShip Center - CameronDreamShip Center - Eau ClaireMilestones Behavioral PediatricsTrio AcademyInsurance Company This insurance company requires prior authorization for ABA therapy. Here are the details to help your clinic complete the prior authorization process.Prior Authorization RequirementsWhat information/forms does clinic need to submit to insurance company?Where does clinic submit the prior authorization documents?Please let us know the date when you have submitted your prior authorization documents to this insurance company. We will then confirm with the insurance company that they have received your prior authorization request, and that it is in process.Prior Authorization ApprovalHow long until clinic receives confirmation from insurance company of what care is approved?How will clinic receive confirmation from insurance company of what care is approved?Choose OneApproval letter by mailApproval letter by faxPhone call from insurance companyOtherAdditional CommentsWhen you receive your prior authorization approval from insurance company, please upload the prior authorization approval letter to us in Teamwork. CommentsThis field is for validation purposes and should be left unchanged. Δ