Get the free (ABA) Services Pre-Authorization Request Form - chip wv
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ABA SERVICES PREAUTHORIZATION REQUEST FORM Submit for PreAuthorization at https://careconnectionwv.kepro.com and Fax/email this form to 18664381360 or chip kepro.com Date of Request: / / From:PreAuthorization
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How to fill out aba services pre-authorization request
How to fill out aba services pre-authorization request
01
Obtain the ABA services pre-authorization request form from your insurance provider.
02
Fill in the required patient information, including name, date of birth, and insurance details.
03
Provide the details of the ABA services being requested, such as the frequency and duration of services.
04
Include any supporting documentation that may be required, such as diagnostic reports or treatment plans.
05
Complete the section related to the healthcare provider or ABA therapist who will be providing the services.
06
Review the completed form for accuracy and ensure all necessary information is provided.
07
Submit the pre-authorization request form to your insurance provider through the designated method (mail, email, online portal, etc.).
08
Keep a copy of the submitted form for your records.
09
Follow up with your insurance provider to confirm receipt of the request and inquire about the status of the authorization process.
Who needs aba services pre-authorization request?
01
ABA services pre-authorization request is needed by individuals who require Applied Behavior Analysis (ABA) therapy for the treatment of behavioral or developmental disorders.
02
This may include individuals with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), or other conditions where ABA therapy is recommended as an evidence-based treatment.
03
The request is typically made by the patient or their legal guardian, in collaboration with the healthcare provider or ABA therapist who will be providing the services.
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