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ABA authorization forms are the official documents healthcare providers, BCBAs, and behavioral health clinicians submit to insurance payers and Medicaid programs to obtain approval before delivering Applied Behavioral Analysis therapy services. These forms are typically required for individuals diagnosed with Autism Spectrum Disorder (ASD) and cover a range of services, from initial assessments and direct one-on-one therapy to family training, group social skills sessions, and BCBA supervision. Because payers have strict documentation requirements, submitting accurate, complete forms with the right clinical supporting materials is essential to avoiding delays, denials, or interruptions in care.
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About ABA authorization forms
Who needs these forms? Primarily BCBAs, supervising providers, and billing staff working with patients enrolled in Medicaid programs, commercial insurance plans, or union benefit funds. Whether you're requesting initial authorization for a new patient, seeking concurrent approval to continue ongoing services, or recertifying an existing treatment plan, each payer — from Medi-Cal and Arkansas Medicaid to Blue Shield of California, Highmark Health Options, and Evernorth — has its own specific form and submission requirements. The 11 forms in this category reflect that variety, spanning state Medicaid programs, managed care organizations, and private insurers.
Because these forms are often multi-page, detail-intensive, and time-sensitive, tools like Instafill.ai use AI to fill them out accurately in under 30 seconds, handling everything from provider credentials and diagnosis codes to service units and treatment plan details — a practical time-saver for busy clinical and administrative teams.
Forms in This Category
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How to Choose the Right Form
Choosing the right ABA authorization form depends primarily on your patient's insurance plan or Medicaid program and the state where services are being provided. Here's how to quickly find the form you need.
Medicaid & State-Specific Forms
If your patient is enrolled in a state Medicaid program, use the form tied to that state or managed care organization:
- Arkansas Medicaid (Summit Community Care): Use the Arkansas Medicaid ABA Authorization Request (ARSMT-CD-095155-25) for services billed under codes 97151–97156.
- Louisiana Medicaid: Use the Louisiana Health Connect ABA Authorization Form (BRO-DP-ABA FORM-0822) — note the 180-day maximum authorization period.
- New Hampshire: Use the ABA Prior Authorization Form (New Hampshire), submitting pages 1–3 for initial evaluations or pages 1–6 for continued services.
- Medi-Cal (California): Use the ABA Authorization Request (Medi-Cal) for services including H0031, H2019, H2012, and related codes.
Commercial & Managed Care Health Plans
If your patient has a commercial or managed care insurance plan, match the form to their insurer:
- Blue Shield of California (commercial plans): Use the Blue Shield of California Prior Authorization Request Form for ABA.
- Health Net Behavioral Health: Use the Health Net ABA Prior Authorization Request Form.
- Evernorth (Cigna behavioral health): Use the Evernorth ABA Prior Authorization Form (928213d), which replaces the telephonic review process.
- Highmark Health Options: Use the Highmark Health Options ABA Prior Authorization Request Form.
- 1199SEIU Benefit Funds: Use the 1199SEIU ABA Prior Authorization Form (ABAPAF) for union benefit fund members.
Medicaid Managed Care / PASSE Programs
- CareSource PASSE (Arkansas): Use the CareSource PASSE ABA Prior Authorization Request Form (AR-PAS-P-2417200a) for members in the PASSE program.
- Coordinated Care (Washington State Medicaid): Use the Coordinated Care ABA Prior Authorization Request Form.
Quick Tips
- Always confirm the member's active plan before selecting a form — submitting to the wrong payer is a common delay.
- Check whether you need an initial request or a concurrent/recertification request, as some forms (like the New Hampshire form) require different pages for each.
- Attach a complete treatment plan and clinical documentation to avoid returned or denied submissions.
Form Comparison
| Form | Payer / Program | Who Files It | Key Distinguishing Feature |
|---|---|---|---|
| ABA Authorization Request (Medi-Cal) – Initial and Concurrent Requests | Medi-Cal (California Medicaid) | ABA providers, BCBAs | Covers both initial and concurrent requests; captures service units by code |
| Applied Behavioral Analysis (ABA) Prior Authorization Request Form (Health Net Behavioral Health Autism Center) | Health Net Behavioral Health Autism Center | Providers, case supervisors | Specifies units per authorization period, per week, or per month |
| Applied Behavioral Analysis (ABA) Prior Authorization Request Form (Coordinated Care) | Coordinated Care (Medicaid plan) | Providers, billing entities | Requires ICD-10 codes, medications, and specific attachments for recertification |
| Applied Behavioral Analysis (ABA) Prior Authorization Form (New Hampshire) | New Hampshire payer (unspecified) | Providers, BCBAs | Separate page sets for initial evaluation vs. continued services |
| Applied Behavioral Analysis (ABA) Authorization Form, Louisiana Health Connect (BRO-DP-ABA FORM-0822) | Louisiana Health Connect (Medicaid) | ABA providers, BCBAs | Authorization limited to 180-day periods; includes symptom severity data |
| Blue Shield of California Prior Authorization Request Form for Applied Behavioral Analysis (ABA) – Commercial Products | Blue Shield of California (commercial) | QAS providers | For commercial (non-Medicaid) members; requires treatment plans and progress reports |
| Evernorth Applied Behavior Analysis (ABA) Prior Authorization Form | Evernorth Behavioral Health | Supervising providers, BCBAs | Replaces telephonic review; includes standardized assessment scores |
| Arkansas Medicaid Applied Behavioral Analysis (ABA) Authorization Request | Summit Community Care (Arkansas Medicaid) | BCBAs, behavioral health providers | Includes behavior reduction plans and functional assessment results |
| Highmark Health Options Applied Behavioral Analysis (ABA) Prior Authorization Request Form | Highmark Health Options | ABA providers | Includes discharge planning details alongside treatment and diagnosis data |
| CareSource PASSE Applied Behavior Analysis (ABA) Prior Authorization Request Form | CareSource PASSE (Arkansas) | ABA providers, BCBAs | Must align with member's Person-Centered Service Plan (PCSP) |
| 1199SEIU Benefit Funds Applied Behavior Analysis (ABA) Prior Authorization Form | 1199SEIU Benefit Funds (union plan) | Providers, credentialed clinicians | For union benefit fund members; covers ASD and other qualifying conditions |
Tips for ABA authorization forms
Each insurer or Medicaid program — from Medi-Cal to Highmark to CareSource — has its own version of the ABA prior authorization form with unique fields and submission requirements. Never substitute one payer's form for another's, as this will almost certainly result in a rejection or delay. Always download the most current version directly from the payer's provider portal before submitting.
Most ABA authorization forms require supporting attachments such as a qualifying diagnostic evaluation, ABA treatment plan, progress reports, standardized assessment scores, and behavior reduction plans. Having these documents ready before you begin filling out the form prevents incomplete submissions and speeds up the review process. Create a checklist for each payer's specific attachment requirements so nothing is missed.
Errors in NPI numbers, TIN, BCBA license numbers, or case supervisor credentials are among the most common reasons ABA authorization requests are returned or denied. Verify every identifier against your credentialing records before submitting, and make sure the supervising BCBA's information matches exactly what the payer has on file. Even a single transposed digit can cause significant processing delays.
ABA authorization forms require specific HCPCS or CPT codes (such as 97151, 97153, H2019, or H0031) along with the exact number of hours or units requested per week, month, or authorization period. Vague or rounded estimates may trigger additional review or reduced approvals. Cross-reference your treatment plan to ensure the codes and units you request accurately reflect the level of care documented.
When managing authorizations across several payers or clients, filling out lengthy multi-page ABA forms manually is extremely time-consuming. AI-powered tools like Instafill.ai can complete these forms in under 30 seconds with high accuracy, and your data stays secure throughout the process. This is especially valuable for practices handling concurrent initial and renewal requests across different insurance programs.
Many ABA authorization forms — such as the New Hampshire and Medi-Cal versions — require different pages or attachments depending on whether the request is for an initial evaluation or a continuation of services. Submitting the wrong set of pages is a common mistake that causes unnecessary delays. Read the form instructions carefully and confirm the request type before assembling your submission packet.
Authorization periods for ABA services are time-limited — for example, Louisiana Health Connect caps them at 180 days per request — and expired authorizations can result in denied claims even when services are clinically appropriate. Build renewal reminders into your scheduling system well before the authorization end date so you have time to gather updated documentation and submit the recertification request. Waiting until the last minute risks gaps in a client's care.
Multiple payers explicitly state that incomplete or illegible ABA authorization forms will be returned without review, restarting the clock on processing time. Review every required field before submitting, and if faxing paper forms, confirm that all pages transmitted clearly. Switching to digital or fillable PDF submissions reduces legibility issues and makes it easier to catch missing fields before the form leaves your office.
Frequently Asked Questions
ABA authorization forms are official utilization management documents that healthcare providers submit to insurance companies or Medicaid programs to obtain prior approval for Applied Behavioral Analysis therapy services. They typically capture patient demographics, provider credentials, diagnosis codes, requested service codes and hours, and supporting clinical documentation to help payers determine medical necessity and approve the appropriate level of care.
Licensed behavioral health providers, Board Certified Behavior Analysts (BCBAs), and supervising clinicians typically submit ABA authorization forms on behalf of their patients. These forms are required before ABA therapy services can begin or continue, and the specific form needed depends on the patient's insurance plan or Medicaid program.
The correct form depends on the patient's insurance carrier or Medicaid managed care organization. For example, patients covered by Health Net, Blue Shield of California, Evernorth, Highmark Health Options, CareSource PASSE, or 1199SEIU Benefit Funds each require their own specific form. State Medicaid programs such as Medi-Cal (California), Louisiana Health Connect, Arkansas Medicaid, and New Hampshire also have their own designated forms.
ABA authorization forms should generally be submitted before treatment begins or before an existing authorization period expires, as most payers require prior approval before services are rendered. For concurrent or continued services, providers should submit renewal requests well in advance of the current authorization end date to avoid interruptions in care.
Most ABA authorization forms require supporting clinical documentation such as a qualifying autism spectrum disorder diagnosis, a comprehensive ABA treatment plan, progress reports, functional behavior assessments, standardized assessment scores, and measurable treatment goals. Initial requests often require more documentation than concurrent or renewal requests, so it is important to review each payer's specific requirements before submitting.
Submitting an incomplete, illegible, or inaccurate ABA authorization form can result in processing delays, returned requests, or adverse coverage determinations. Providers should carefully review all required fields and attach the necessary clinical documentation before submission to avoid interruptions in a member's ABA therapy services.
Authorization forms typically cover a range of ABA service codes, including behavior assessments, direct one-on-one therapy, BCBA supervision, protocol modification, parent and family training, and group social skills sessions. The specific service codes covered vary by payer, so providers should confirm which procedure codes are included in each authorization request.
Authorization periods vary by payer and program. Some authorizations are granted for 90-day or 180-day periods, while others may be issued on a monthly or annual basis. For example, Louisiana Health Connect limits authorization periods to a maximum of 180 days per request, and providers must submit a new form before the period expires to continue services.
Completed ABA authorization forms are submitted directly to the relevant insurance carrier or Medicaid managed care organization, either by fax, mail, or through an online provider portal. Each payer specifies its preferred submission method, so providers should refer to the instructions on the specific form or the payer's provider manual for guidance.
Yes, AI-powered tools like Instafill.ai can fill out ABA authorization forms in under 30 seconds by accurately extracting and placing data from source documents such as treatment plans, assessment reports, and member records. This significantly reduces manual data entry errors and speeds up the submission process for busy behavioral health practices.
Manually completing a multi-page ABA authorization form can take anywhere from 20 minutes to over an hour, depending on the complexity of the form and the availability of clinical documentation. Using AI-powered services like Instafill.ai, providers can complete these forms in under 30 seconds, with data accurately extracted and populated from existing clinical records.
No, receiving an ABA authorization is not a guarantee of payment. Payers typically require that the member be eligible for coverage at the time services are rendered and that services are delivered in accordance with the approved plan. Providers should verify member eligibility before each service date and ensure that all services align with the authorized treatment plan.
Glossary
- ABA (Applied Behavior Analysis)
- A therapy based on the science of learning and behavior, most commonly used to treat Autism Spectrum Disorder. It focuses on improving specific behaviors such as communication, social skills, and adaptive learning skills.
- Prior Authorization
- A requirement by a health insurance plan that a provider must obtain approval before delivering certain services in order for those services to be covered. Without prior authorization, the payer may deny payment even if the service was medically necessary.
- BCBA (Board Certified Behavior Analyst)
- A graduate-level certification in behavior analysis awarded by the Behavior Analyst Certification Board. BCBAs are typically the supervising clinicians who design ABA treatment plans and are required to be identified on most ABA authorization forms.
- NPI (National Provider Identifier)
- A unique 10-digit identification number assigned to healthcare providers by the federal government. It is required on authorization forms to identify the billing provider, supervising clinician, or treating therapist.
- TIN (Tax Identification Number)
- A number used by the IRS to identify a business or individual for tax purposes, often required on authorization forms to identify the billing organization or practice submitting the request.
- HCPCS/CPT Codes
- Standardized medical billing codes used to describe specific services or procedures. On ABA authorization forms, codes such as 97151, 97153, 97155, H2019, and H0031 identify the exact type of ABA service being requested for approval.
- ICD-10 Diagnosis Code
- A standardized alphanumeric code from the International Classification of Diseases used to identify a patient's medical condition. ABA authorization forms require these codes—such as F84.0 for Autism Spectrum Disorder—to establish medical necessity.
- Medical Necessity
- A standard used by payers to determine whether a requested service is appropriate, reasonable, and required for the diagnosis or treatment of a condition. Authorization requests must include clinical documentation demonstrating that ABA services meet this standard.
- Utilization Management (UM)
- A process used by health plans to evaluate the appropriateness and efficiency of healthcare services before, during, or after they are provided. ABA authorization forms are submitted to a payer's UM team for review and approval.
- Authorization Period
- The specific time span during which approved ABA services may be delivered, often expressed in weeks or months (e.g., up to 180 days). Providers must submit a new authorization request before this period expires to continue services without interruption.