HNFS encourages beneficiaries to contact the ABA provider listed on the approval to set up the initial appointment if the ABA provider has not contacted the beneficiary within three business days. The letter contains contact information for the beneficiary and ABA provider. Providers and beneficiaries can view a copy of the determination letter online (log in to access your Secure Inbox and/or our Check Authorization Status tool). We encourage ABA providers to submit the request for treatment promptly following the last day of the assessment to help reduce the length of time between the end of the assessment period and the approval to initiate treatment.
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ABA provider must conduct CPT code 97153, 97155 or 97156 services within 28 calendar days of the last date of initial assessment in the 14-day window that is allowed for CPT code 97151 after an authorization to start treatment has been approved.HNFS confirms the access-to-care standard was met for the initial assessment or obtains rationale if not met.As HNFS has up to 15 business days to complete active provider placement, the ABA provider needs to ensure the first date of service of CPT code 97151 is completed within 28 days of the “service from date” on the initial assessment authorization.After receiving an approved authorization to start the initial assessment, ABA providers must provide the first date of service of the assessment (Current Procedural Terminology code 97151) within 28 calendar days from the date HNFS verified the referral for the assessment.
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Once the referral for ABA services has been authorized for the initial assessment, ABA providers can start the initial assessment. After HNFS has verified a referral for ABA services, we may pend the request for initial provider placement (“Pended – Initial Provider Placement”) for up to 15 business days.