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Therapy request forms are clinical and administrative documents used to seek authorization for specialized therapeutic services, most commonly Applied Behavior Analysis (ABA) therapy for individuals diagnosed with Autism Spectrum Disorder. These forms are typically required by Medicaid programs, private insurers, or managed care organizations before services can begin, ensuring that the requested treatment meets established medical necessity criteria. They capture detailed information including patient diagnoses, clinical history, behavioral assessments, treatment goals, and recommended service hours — all of which help reviewers determine whether the proposed therapy is appropriate and covered under the member's plan.
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About therapy request forms
These forms are most often completed by licensed clinicians such as Board-Certified Behavior Analysts (BCBAs) or other approved providers on behalf of their patients. Parents and caregivers may also encounter them when navigating insurance coverage for a child's ABA therapy. Whether you're submitting the Alabama Medicaid Agency ABA Therapy Assessment Form for CPT 97151 authorization or a SmartHealth prior authorization request, accuracy and completeness are critical — missing or vague documentation is one of the most common reasons for delays or denials.
Because these forms require precise clinical data and careful attention to detail, tools like Instafill.ai use AI to fill them out in under 30 seconds, reducing the administrative burden on providers while helping ensure the information is entered accurately and securely.
Forms in This Category
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How to Choose the Right Form
Both forms on this page are used to request authorization for Applied Behavior Analysis (ABA) therapy for individuals diagnosed with Autism Spectrum Disorder — but they serve different payers and have distinct requirements. Here's how to choose the right one:
You need the Alabama Medicaid ABA Therapy Assessment Form if:
- The patient is enrolled in Alabama Medicaid
- You are a Board-Certified Behavior Analyst (BCBA) or an Alabama Medicaid-approved provider
- You are requesting authorization specifically for a behavior assessment and treatment planning service billed under CPT 97151
- You need to document DSM-5 evaluation findings, baseline behaviors, measurable goals, and recommended treatment hours to establish medical necessity for Medicaid reviewers
- You also need to address whether services are distinct from any school-based or IEP-related services the patient receives
You need the SmartHealth ABA Therapy Request Form if:
- The patient is a SmartHealth member (not covered under Alabama Medicaid)
- You are seeking prior authorization before ABA therapy services begin
- You need to submit service codes, unit counts, a treatment plan, a functional behavior assessment, and a standardized assessment together as a package
- Authorization must be obtained before services are rendered, and the completed form must be faxed to SmartHealth with all supporting documentation
Quick Comparison
| | Alabama Medicaid Form | SmartHealth Form |
|---|---|---|
| Payer | Alabama Medicaid | SmartHealth |
| CPT Code | 97151 | Multiple service codes |
| Completed by | BCBA / approved provider | Treating provider |
| Key focus | Assessment & treatment planning | Prior authorization for therapy services |
Not sure which applies? Check the patient's insurance card or benefits documentation to confirm whether they are covered under Alabama Medicaid or SmartHealth before submitting.
Form Comparison
| Form | Purpose | Who Files It | When to Use |
|---|---|---|---|
| Alabama Medicaid Agency ABA Therapy Assessment Form (6/20/19) | Request authorization for ABA behavior assessment (CPT 97151) | Board-Certified Behavior Analyst (BCBA) or approved provider | Before billing ABA assessment services under Alabama Medicaid |
| Applied Behavior Analysis (ABA) Therapy Request Form | Prior authorization for ABA therapy services from SmartHealth | Provider submitting on behalf of SmartHealth member | Before rendering any ABA therapy services to covered members |
Tips for therapy request forms
ABA therapy request forms like the SmartHealth prior authorization form must be submitted and approved before therapy sessions start — not after. Rendering services without prior authorization can result in claim denials and leave providers or families responsible for costs. Always confirm authorization is in place before scheduling the first session.
These forms rarely stand alone — they typically require attachments such as a standardized behavior assessment, a functional behavior assessment (FBA), and an individualized treatment plan. Missing even one supporting document is a leading cause of delays or outright denials. Prepare your documentation package before submitting the form so everything goes in together.
Generic or templated clinical descriptions are a red flag for Medicaid and insurance reviewers. Targeted behaviors, baseline data, and treatment goals must be specific to the individual patient and written in measurable terms. Reviewers use this information to determine medical necessity, so vague language can trigger additional review or denial.
For Medicaid-funded ABA requests, reviewers specifically look for evidence that the requested services are clinically necessary and distinct from what is already provided through school-based services or an IEP. Clearly document what educational services the patient receives and explain why the clinical ABA services address separate, medically necessary needs.
Errors in CPT codes (such as 97151 for behavior assessments) or incorrect unit counts are among the most common administrative mistakes on ABA request forms. A single digit error can result in a denial or require a full resubmission. Cross-reference the payer's covered service list before entering codes and units.
AI-powered tools like Instafill.ai can complete ABA therapy request forms accurately in under 30 seconds, pulling in patient, provider, and clinical details with minimal manual entry. This is especially valuable when managing multiple authorization requests across different payers. Your data stays secure throughout the process, making it a practical time-saver for busy BCBA practices and care coordinators.
Many ABA therapy request forms, including the SmartHealth form, must be faxed to a specific number rather than submitted online or by mail. Sending to the wrong fax number can cause significant delays and may result in services being rendered without authorization. Confirm the current submission fax number directly with the payer before sending, as these can change.
Always retain a dated copy of the completed form and all supporting documents you submit. If a payer claims they never received the request or asks for resubmission, having your own records protects the provider and helps resolve disputes quickly. A simple filing system — even a labeled folder per patient — can save significant time during audits or appeals.
Frequently Asked Questions
Therapy request forms are used to obtain prior authorization from insurance or Medicaid programs before therapy services can begin. They document medical necessity, diagnosis information, and treatment plans so that payers can review and approve the requested services. Without an approved request form, providers may not receive reimbursement for services rendered.
These forms are generally completed by licensed or certified clinical providers, such as Board-Certified Behavior Analysts (BCBAs) or other approved therapy providers. The provider must supply clinical findings, diagnosis documentation, and a treatment plan to support the request. Patients or caregivers do not typically fill out these forms themselves, though they may need to provide some identifying information.
The form you need depends on the patient's insurance coverage. If the patient is covered by Alabama Medicaid, you would use the Alabama Medicaid Agency ABA Therapy Assessment Form (CPT 97151). If the patient is a SmartHealth member, you would use the SmartHealth Applied Behavior Analysis (ABA) Therapy Request Form. Always confirm the patient's active coverage before selecting and submitting a form.
Yes, both forms in this category are specifically designed for ABA therapy services for individuals diagnosed with Autism or Autism Spectrum Disorder (ASD). The Alabama Medicaid form references DSM-5 criteria for ASD, and the SmartHealth form requires an ICD-10 diagnosis code of F84.0 (Autism Spectrum Disorder). Other therapy types or diagnoses would require different authorization forms.
Most ABA therapy request forms require supporting clinical documentation alongside the completed form. This commonly includes a standardized assessment, an individualized treatment plan, and a functional behavior assessment. Submitting incomplete documentation is one of the most common reasons for delays or denials, so providers should review the specific requirements for each payer before submitting.
Therapy request forms should be submitted before ABA services begin, as they are prior authorization documents. Rendering services without an approved authorization can result in claim denials and non-reimbursement. Providers should allow adequate processing time and confirm authorization approval before scheduling or starting treatment.
Submission methods vary by payer. The SmartHealth ABA Therapy Request Form must be faxed to a designated number prior to services being rendered. The Alabama Medicaid ABA form is submitted through Alabama Medicaid's administrative review process. Always check the specific submission instructions on the form or the payer's provider portal for the most current contact and submission details.
Incomplete or non-patient-specific documentation is a leading cause of authorization delays or outright denials. Reviewers need sufficient clinical detail to determine whether the requested services are medically necessary and appropriate. Providers should carefully review all required fields and attach all supporting documents before submitting to avoid unnecessary delays in care.
Yes, AI-powered tools like Instafill.ai can fill out therapy request forms in under 30 seconds by accurately extracting and placing data from source documents such as clinical records and patient files. Instafill.ai can also convert non-fillable PDF versions of these forms into interactive fillable forms, making the process faster and reducing the risk of manual entry errors.
Using an AI-powered service like Instafill.ai, these forms can typically be completed in under 30 seconds, as the AI automatically extracts relevant information from uploaded source documents and populates the appropriate fields. This is significantly faster than manual data entry and helps ensure accuracy across complex clinical and administrative fields.
ABA therapy authorizations are generally time-limited and may need to be renewed when the authorization period expires or when treatment goals or hours change significantly. Providers should track authorization end dates and submit renewal requests in advance to avoid gaps in approved services. The specific renewal timeline will depend on the payer's policies.
Coverage for ABA therapy varies by insurance plan, state mandates, and the patient's specific policy. Both forms in this category represent specific payers — Alabama Medicaid and SmartHealth — each with their own coverage criteria and authorization requirements. Providers should verify the patient's benefits and confirm that ABA therapy is a covered service before initiating the authorization process.
Glossary
- Prior Authorization (PA)
- Approval required from an insurance plan or Medicaid before certain services can be provided and covered. Without prior authorization, claims for ABA therapy may be denied even if the treatment is medically appropriate.
- Applied Behavior Analysis (ABA)
- A therapy approach based on the science of behavior and learning, commonly used to improve social, communication, and adaptive skills in individuals with Autism Spectrum Disorder. It is the therapy type these request forms are designed to authorize.
- Medical Necessity
- A standard used by insurers and Medicaid to determine whether a requested service is clinically appropriate, necessary to treat a diagnosed condition, and not primarily for educational purposes. Demonstrating medical necessity is required for ABA therapy authorization.
- Board-Certified Behavior Analyst (BCBA)
- A credentialed professional who has met national certification requirements to design and oversee ABA therapy programs. Medicaid and insurance plans typically require a BCBA to complete and sign therapy request forms.
- CPT Code 97151
- A Current Procedural Terminology billing code specifically for a behavior identification assessment conducted by a BCBA. This code is used on ABA request forms to identify and bill for the initial assessment service.
- Autism Spectrum Disorder (ASD) / ICD-10: F84.0
- A neurodevelopmental diagnosis that qualifies individuals for ABA therapy coverage under Medicaid and most insurance plans. The ICD-10 code F84.0 is the standardized diagnosis code for Autism that must be documented on these forms.
- Functional Behavior Assessment (FBA)
- A clinical evaluation process that identifies the causes and patterns of specific problem behaviors in order to guide treatment planning. An FBA is typically required as supporting documentation when submitting an ABA therapy request.
- Individualized Education Program (IEP)
- A legally mandated educational plan for students with disabilities, developed by schools rather than medical providers. ABA therapy request forms ask about IEP status to help reviewers distinguish between educational services and medically necessary treatment.
- DSM-5
- The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, which provides the standardized criteria used to diagnose Autism Spectrum Disorder. Forms may require documentation that a patient meets specific DSM-5 criteria to support the ABA therapy request.
- Treatment Units
- The number of billable time increments (typically 15-minute blocks) of therapy being requested for a given period. Providers must specify the number of units per service code on the request form to indicate the scope of treatment needed.