Clinical Necessity Reviews

Your child’s ABA provider will request authorization for your child’s ABA services. TRICARE East’s clinical team of BCBAs will evaluate your child’s treatment plan and outcome measures to assess their progress.

The review examines:

• Signed TPs
• Goals targeting core ASD symptoms
• Outcome measure scores
• Level of clinical support
• Duration in ABA services
• Location of services
• Parent training sessions
• Requested hours of ABA services
• Policy exclusions

Should we need more information, we will notify your child’s ABA provider. We will continue our review once we receive the requested information. If your provider does not submit this information in a timely manner, there may be a gap in your child’s services.

It is important that your child does not begin services until you receive the six month approval notice to avoid gaps in care or issues with claims.