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PASSE forms are documents used within Arkansas's Provider-led Aligned Safety-net System (PASSE), a managed care model designed to coordinate services for individuals with complex behavioral health needs, developmental disabilities, and other qualifying conditions. These forms play a critical role in ensuring that members receive the right services at the right time, with prior authorizations, service plans, and clinical documentation helping to align care with each member's individual needs. One key example in this category is the CareSource PASSE Applied Behavior Analysis (ABA) Prior Authorization Request Form, which providers must complete to obtain pre-approval for delivering ABA therapy services to members diagnosed with Autism Spectrum Disorder.
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About PASSE forms
These forms are primarily used by healthcare providers, behavioral health specialists, BCBAs, and care coordinators who work within the PASSE network. Whether requesting authorization for direct therapy sessions, supervision hours, or parent training, accurate and complete form submission is essential — errors or missing information can delay approvals and ultimately affect member access to care.
Because these forms often require precise clinical codes, member details, and supporting documentation, getting them right the first time matters. Tools like Instafill.ai use AI to help providers fill out these forms in under 30 seconds, reducing administrative burden while keeping sensitive information accurate and secure.
Forms in This Category
| Form Name | Pages | |
|---|---|---|
| 1. | CareSource PASSE Applied Behavior Analysis (ABA) Prior Authorization Request Form | 2 |
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How to Choose the Right Form
If you've landed on this page, you're likely a provider or administrator working within the CareSource PASSE network and need to request pre-approval for therapy services. Here's what to know to move forward quickly.
Who This Form Is For
This category currently features one essential document:
- CareSource PASSE Applied Behavior Analysis (ABA) Prior Authorization Request Form — designed specifically for providers (BCBAs, ABA therapy agencies, and supervising clinicians) who need prior authorization before delivering ABA services to CareSource PASSE members diagnosed with Autism Spectrum Disorder (ASD).
When You Need This Form
Use this form if you are:
- A BCBA or ABA provider requesting approval for services such as direct therapy, BCBA supervision, parent/family training, or group adaptive behavior sessions
- Submitting service codes 97151–97158 EP for a member with an active ASD diagnosis
- Aligning a new or renewed treatment plan with the member's Person-Centered Service Plan (PCSP)
What to Have Ready Before You Start
To complete the form accurately, gather the following in advance:
- Member ID and demographic information
- Diagnosis codes confirming ASD
- Specific service codes, requested hours, and units
- Supporting clinical documentation tied to the member's PCSP
Important Reminders
- Authorization is not a guarantee of payment — confirm member eligibility at the time services are rendered.
- Submit the form before services begin to avoid claim denials.
- Use Instafill.ai to fill out the form quickly using AI assistance, especially if you're working with a non-fillable PDF version.
If you're unsure whether this form applies to your situation, contact CareSource PASSE directly or consult your provider relations representative.
Form Comparison
| Form | Purpose | Who Files It | When to Use |
|---|---|---|---|
| CareSource PASSE Applied Behavior Analysis (ABA) Prior Authorization Request Form | Request pre-approval for ABA therapy services for autism members | Healthcare providers and BCBAs treating CareSource PASSE members | Before delivering ABA services to members with Autism Spectrum Disorder |
Tips for PASSE forms
Authorization approval does not guarantee payment — the member must be eligible at the time services are actually rendered. Always verify the member's current CareSource PASSE eligibility status before submitting the prior authorization request and again before delivering services.
The ABA prior authorization form requires specific diagnosis codes confirming an Autism Spectrum Disorder diagnosis alongside the correct ABA service codes (97151–97158 EP). Missing or incorrect codes are a leading cause of delays or denials, so double-check each code against the member's clinical documentation before submission.
CareSource PASSE requires that requested ABA services — including direct therapy, BCBA supervision, parent/family training, and group sessions — align with the member's Person-Centered Service Plan (PCSP). Review the PCSP carefully and ensure the hours and units you request are clearly supported by the plan on file.
Vague or rounded estimates for requested hours and units can trigger additional review or requests for more information. Use the member's assessment data and treatment plan to calculate specific, clinically justified numbers rather than broad approximations.
Submitting the form without required supporting documentation — such as the initial ABA assessment, treatment plan, or progress notes for reauthorizations — is one of the most common reasons for processing delays. Gather all supporting materials before you begin filling out the form so nothing is overlooked.
AI-powered tools like Instafill.ai can accurately complete the CareSource PASSE ABA Prior Authorization Request Form in under 30 seconds, reducing manual data entry errors and saving significant time — especially when managing multiple authorization requests. Your data stays secure throughout the process, making it a practical choice for busy provider offices.
If you receive a scanned or non-fillable PDF version of the PASSE form, trying to type over it manually can cause formatting issues and errors. Tools like Instafill.ai can convert non-fillable PDFs into interactive fillable forms, making the process much smoother and reducing the risk of incomplete submissions.
Always save a complete copy of the submitted form along with any confirmation or reference numbers provided by CareSource PASSE. This documentation is essential if a dispute arises over payment or if you need to reference the original authorization details during a reauthorization request.
Frequently Asked Questions
PASSE stands for Provider-led Arkansas Shared Savings Entity, a managed care model in Arkansas designed to coordinate services for individuals with complex behavioral and physical health needs. Providers who deliver specialized services—such as Applied Behavior Analysis (ABA) therapy—to CareSource PASSE members are required to use PASSE forms to request prior authorizations and ensure services are covered.
This form is used by healthcare providers to request pre-approval from CareSource PASSE before delivering ABA therapy services to members diagnosed with Autism Spectrum Disorder (ASD). It covers a range of ABA service types, including direct therapy, BCBA supervision, parent and family training, and group adaptive behavior sessions.
ABA services under CareSource PASSE are intended for members who have a confirmed Autism Spectrum Disorder diagnosis and are enrolled in the CareSource PASSE program. Members must be eligible at the time services are actually rendered, as prior authorization alone does not guarantee payment.
Licensed and credentialed ABA therapy providers, including Board Certified Behavior Analysts (BCBAs) and their supervising agencies, are responsible for submitting this form. The provider must be enrolled with CareSource PASSE and authorized to deliver the specific ABA service codes listed on the form (97151–97158 EP).
The form requires detailed provider and member information, relevant diagnosis codes, specific ABA service codes, the number of requested hours and units, and supporting clinical documentation. Providers should also ensure the requested services align with the member's Person-Centered Service Plan (PCSP).
No, prior authorization is not a guarantee of payment. CareSource PASSE requires that the member remains eligible at the time services are rendered, and payment is also subject to other plan requirements and billing accuracy. Providers should verify member eligibility before each service date.
Completed forms should be submitted to CareSource PASSE through their designated submission channels, which may include fax, an online provider portal, or mail as specified in the form instructions or CareSource PASSE provider guidelines. Providers should refer to the most current CareSource PASSE provider resources for submission details.
Providers are generally advised to submit prior authorization requests well in advance of the planned service start date to allow adequate processing time. Submitting early helps avoid delays in care and ensures that approval is in place before services begin, though specific timelines should be confirmed with CareSource PASSE directly.
Providers typically need to include clinical documentation such as the member's ASD diagnosis, relevant assessment results, treatment plans, and evidence that the requested services align with the member's Person-Centered Service Plan (PCSP). Thorough documentation strengthens the request and can help speed up the review process.
Yes, AI-powered tools like Instafill.ai can fill out PASSE forms such as the CareSource ABA Prior Authorization Request Form in under 30 seconds by accurately extracting and placing data from source documents. This reduces manual entry errors and saves significant time for busy providers and administrative staff.
Manually completing the form can take anywhere from 10 to 30 minutes depending on the complexity of the case and the availability of supporting information. Using AI-powered services like Instafill.ai, the same form can be filled out in under 30 seconds by automatically pulling relevant data from existing documents.
Incomplete or inaccurate forms may result in delays, denials, or requests for additional information from CareSource PASSE, which can postpone the start of necessary therapy for the member. Providers should carefully review all fields, ensure diagnosis and service codes are correct, and include all required supporting documentation before submitting.
Glossary
- PASSE
- Provider-led Arkansas Shared Savings Entity — a managed care organization in Arkansas that coordinates physical health, behavioral health, and long-term services for Medicaid members with complex needs, including those with developmental disabilities or autism.
- Prior Authorization (PA)
- A required pre-approval from CareSource PASSE that a provider must obtain before delivering certain services, such as ABA therapy, to confirm the treatment is medically necessary and covered under the member's plan.
- Applied Behavior Analysis (ABA)
- A therapy based on the science of learning and behavior, commonly used to improve social, communication, and adaptive skills in individuals diagnosed with Autism Spectrum Disorder (ASD).
- BCBA
- Board Certified Behavior Analyst — a credentialed professional who designs, oversees, and supervises ABA therapy programs; BCBA supervision sessions are a billable service type included on this authorization form.
- Person-Centered Service Plan (PCSP)
- An individualized care plan developed collaboratively with the member and their support team that outlines their goals, needs, and approved services; ABA therapy must align with this plan to receive authorization.
- Service Codes (97151–97158 EP)
- CPT billing codes specific to ABA therapy services — ranging from behavior identification assessments (97151) to group adaptive behavior treatment (97158) — that providers must list on the authorization request to specify which services are being requested.
- Autism Spectrum Disorder (ASD)
- A neurodevelopmental condition characterized by challenges in social interaction, communication, and repetitive behaviors; a confirmed ASD diagnosis is required for members to qualify for ABA therapy authorization through CareSource PASSE.
- Units
- The standard measurement used to quantify ABA therapy services for billing and authorization purposes, typically representing 15-minute increments of service time that providers must specify when requesting approval.
- Rendering Provider
- The individual clinician or therapist who directly delivers the ABA therapy services to the member, as distinguished from the billing provider or supervising BCBA listed on the authorization form.
- NPI (National Provider Identifier)
- A unique 10-digit identification number required by HIPAA for all healthcare providers; both the billing organization and the rendering provider must include their NPIs on the authorization request form.