Autism Care Demonstration: Common Reasons for Additional Information Requests

Thursday, May 16, 2024

When an applied behavior analysis (ABA) authorization request does not have elements required by TRICARE, Health Net Federal Services, LLC (HNFS) will pend the request for up to 10 business days and fax an additional information request (AIR) letter to the ABA provider. Your timely response to AIRs will help prevent treatment delays. The following are common reasons HNFS faxes AIRs to ABA providers.

1. Treatment plans that do not address all TRICARE requirements. Frequently omitted or incorrect information includes:
   
   
   • Missing symptom severity level (1-mild, 2-moderate, 3-severe).
   • Missing detailed explanations for stagnation or regression.
   • Incorrect beneficiary name (misspelled or nickname used).
   • Lack of objective, measurable discharge criteria individualized to beneficiary.
   • Missing goals criteria or goals not targeting autism spectrum disorder (ASD) symptoms (exclusions).
   • Missing documentation requirements, such as justifications for school and community locations.
   • Lack of detail in parent/caregiver training and progress summaries.
      
2. Incomplete or incorrect outcome measures. Outcome measures must:
   
   
   • Include the score summary or hand-scored protocol and summary score sheets. 
   • Be performed within 90 days of due dates. 
   • Have scores within the publisher’s limits. 
   • Not have scores embedded in the treatment plan.
      

Before submitting a request for ABA services to HNFS, be sure to confirm the treatment plan meets minimum TRICARE Operations Manual, Chapter 18, Section 4 guidelines.

Visit our ACD page for comprehensive details on completing treatment plans and outcome measures.