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ABA referral forms are official documents used to establish medical necessity and initiate Applied Behavioral Analysis therapy services for individuals — most commonly children and adults diagnosed with autism spectrum disorder. These forms serve as the bridge between a treating physician or psychologist and the insurance or Medi-Cal systems that authorize and fund ABA services. Without a properly completed referral, access to critical behavioral health support can be delayed or denied entirely.
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About ABA referral forms
The forms in this category are typically completed by licensed physicians or psychologists on behalf of their patients. A common example is the Health Net Applied Behavioral Analysis (ABA) Recommendation and Referral Form (24-989), which is required by the California Department of Health Care Services for Medi-Cal members seeking ABA therapy through Health Net. These documents require precise clinical information — including diagnosis codes, member details, and provider signatures — making accuracy essential.
Because these forms involve detailed medical and administrative data, even small errors can cause delays in care. Tools like Instafill.ai use AI to fill these forms accurately in under 30 seconds, and can even convert non-fillable PDF versions into interactive forms — a practical time-saver for busy healthcare providers and families navigating the referral process.
Forms in This Category
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How to Choose the Right Form
If you've landed on this page looking for an ABA referral form, here's what you need to know to move forward quickly.
Who This Form Is For
This category currently features one primary form:
- Health Net Applied Behavioral Analysis (ABA) Recommendation and Referral Form (24-989) — designed specifically for Health Net Medi-Cal members in California who need ABA therapy services, most commonly for individuals diagnosed with autism spectrum disorder (ASD).
When You Need This Form
Use the Health Net ABA Referral Form (24-989) if:
- The patient is a Medi-Cal member covered under Health Net
- A licensed physician or psychologist has determined ABA therapy is medically necessary
- You need to formally connect the member to an in-network ABA provider through Health Net's Behavioral Health Autism Center
- You are required to demonstrate compliance with California DHCS requirements
Who Can Complete It
This form must be completed and signed by a licensed physician or psychologist — it cannot be submitted by a parent, caregiver, or patient alone. Make sure the referring provider has the member's diagnosis, relevant clinical details, and referral rationale ready before starting.
Not Sure If This Is the Right Form?
- If the patient has a different insurance carrier, contact that insurer directly for their specific ABA referral documentation.
- If you're seeking school-based or regional center ABA services, different referral processes apply and this form would not be appropriate.
Tips for Filling It Out
The 24-989 form can be complex, requiring precise medical and member information. Using an AI-powered tool like Instafill.ai can help you complete it accurately and convert non-fillable PDF versions into interactive forms — saving time and reducing errors.
Form Comparison
| Form | Purpose | Who Files It | When to Use |
|---|---|---|---|
| Health Net Applied Behavioral Analysis (ABA) Recommendation and Referral Form (24-989) | Establish medical necessity for ABA therapy services | Licensed physician or psychologist | When referring Medi-Cal members for ABA autism services |
Tips for ABA referral forms
ABA referral forms like the Health Net 24-989 must be signed and completed by a licensed physician or psychologist — not administrative staff or parents. Submitting a form with an unauthorized signature can result in delays or outright denial of ABA therapy services.
The form requires a documented diagnosis, typically autism spectrum disorder (ASD), along with supporting clinical rationale for why ABA therapy is medically necessary. Vague or incomplete diagnostic information is one of the most common reasons these referrals are returned or rejected.
Double-check the member's Health Net ID number, date of birth, and Medi-Cal eligibility before completing the form. Even small data entry errors can cause the referral to be misrouted or require resubmission, adding weeks to the process.
Health Net requires that ABA referrals connect members to an approved in-network provider through the Behavioral Health Autism Center. Always verify the receiving ABA provider's network status before submitting to avoid authorization issues down the line.
AI-powered tools like Instafill.ai can fill out ABA referral forms quickly and accurately, reducing the risk of manual data entry errors that slow down approvals. Your data stays secure throughout the process, making it a practical time-saver for busy clinicians and care coordinators managing multiple referrals.
Some versions of ABA referral forms are scanned or non-fillable PDFs, which can make completion frustrating and error-prone. Tools like Instafill.ai can convert these into interactive fillable forms, so you can type directly into fields rather than printing and handwriting responses.
Always save a completed copy of the referral form before sending it to Health Net, as you may need to reference it if there are questions about the submission or if the referral needs to be resubmitted. Organizing these by member name and submission date makes follow-up much easier.
ABA therapy authorizations are time-sensitive, and delays in submitting the referral form can result in gaps in services for individuals who need consistent behavioral support. Completing and submitting the form as soon as a diagnosis is confirmed helps ensure continuity of care.
Frequently Asked Questions
An ABA referral form is an official document used to request Applied Behavioral Analysis therapy services for a patient, typically someone diagnosed with autism spectrum disorder. It establishes medical necessity and connects the member to an appropriate ABA provider through their health plan or insurer.
ABA referral forms must be completed by a licensed physician or psychologist who has evaluated the patient and determined that ABA therapy is medically necessary. The form is submitted on behalf of the patient — often a child with autism spectrum disorder — to initiate coverage and services through their health plan.
This category contains the Health Net Applied Behavioral Analysis (ABA) Recommendation and Referral Form (24-989), which is specifically used for Medi-Cal members seeking ABA therapy services through Health Net in California. It is required by the California Department of Health Care Services (DHCS).
An ABA referral form should be submitted as soon as a licensed physician or psychologist has assessed the patient and determined that ABA therapy is medically necessary. Submitting promptly helps ensure timely access to services, as processing and authorization may take additional time.
The completed Health Net ABA Recommendation and Referral Form (24-989) should be submitted to Health Net's Behavioral Health Autism Center, as directed by Health Net's submission guidelines. It is best to confirm the current submission method — such as fax, mail, or online portal — directly with Health Net or your provider's office.
ABA referral forms generally require the member's personal and insurance information, a clinical diagnosis (such as autism spectrum disorder), the reason for the referral, and the referring provider's signature and credentials. Some forms also ask for the recommended type or intensity of ABA services.
No — ABA referral forms like the Health Net form (24-989) must be completed and signed by a licensed physician or psychologist, not the patient's parent or caregiver. However, parents and caregivers can gather the necessary member information and work with their provider's office to ensure the form is completed accurately.
While ABA therapy is most commonly associated with children diagnosed with autism spectrum disorder, the eligibility criteria depend on the health plan's policies and the DHCS requirements. It is best to consult with the referring provider or Health Net directly to confirm eligibility for members of all ages.
Yes — AI-powered tools like Instafill.ai can fill out ABA referral forms in under 30 seconds by accurately extracting and placing data from source documents such as patient records or insurance cards. Instafill.ai can also convert non-fillable PDF versions of these forms into interactive, fillable formats.
Filling out an ABA referral form manually can take several minutes, especially when gathering clinical and insurance details. Using AI tools like Instafill.ai, the process can be completed in under 30 seconds, reducing administrative burden for busy medical offices.
After submission, the health plan reviews the form to verify medical necessity and determine authorization for ABA services. If approved, the member is connected with an in-network ABA provider; if additional information is needed, the health plan or provider's office will typically follow up.
No — ABA referral forms vary by health plan and state requirements. The Health Net ABA Recommendation and Referral Form (24-989) is specific to Health Net Medi-Cal members in California, and other insurers or state programs may have their own distinct forms and submission processes.
Glossary
- ABA (Applied Behavioral Analysis)
- A therapy approach based on the science of learning and behavior, commonly used to improve social, communication, and learning skills in individuals with autism spectrum disorder.
- Medical Necessity
- A determination by a licensed healthcare provider that a treatment or service is appropriate and required to diagnose or treat a patient's condition; ABA services must meet this standard to be covered by Medi-Cal.
- Medi-Cal
- California's Medicaid program that provides free or low-cost health coverage to eligible low-income residents, including coverage for ABA therapy for members diagnosed with autism spectrum disorder.
- DHCS (Department of Health Care Services)
- The California state agency that oversees Medi-Cal and sets the requirements and guidelines for covered services, including ABA therapy authorization and referral procedures.
- Autism Spectrum Disorder (ASD)
- A developmental condition affecting communication, behavior, and social interaction, and the primary diagnosis for which ABA therapy referrals are typically submitted.
- Behavioral Health Autism Center
- Health Net's specialized network of providers and coordinators dedicated to managing and delivering ABA therapy services for eligible Medi-Cal members.
- In-Network Provider
- A healthcare provider or facility that has a contracted agreement with a health plan like Health Net, typically resulting in lower costs and streamlined authorization for services.
- Referring Physician/Psychologist
- The licensed medical professional (MD, DO, or PhD-level psychologist) who completes and signs the ABA referral form, certifying the member's diagnosis and the medical necessity of ABA services.
- Prior Authorization
- Approval required from a health plan before certain services, like ABA therapy, can begin; the referral form is a key step in initiating this approval process.