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January 2018

Autism coverage changing for NASCO non-auto ASC groups

Blue Cross Blue Shield of Michigan recently sent a letter to members who are part of NASCO non-auto ASC groups and whose children currently are receiving applied behavioral analysis. The letter advised them of changes to their autism coverage beginning Jan. 1, 2018.

Among the most significant changes to the ABA coverage are the following:

  • Must obtain preauthorization through New Directions for ABA services provided on or after Jan. 1, 2018.
  • The preauthorization process begins with an evaluation by an approved autism evaluation center or an out-of-state equivalent.

The letter advised them that they must schedule the evaluation by Friday, Dec. 29, 2017. (While the evaluation can take place after this date, it needed to be scheduled no later than Dec. 29, 2017.) Once the appointment has been scheduled, members must advise New Directions of the date of the appointment so that the patient can continue to receive ABA therapy while waiting for the evaluation.

As always, be sure to check the benefits and eligibility of your patients with Blue Cross insurance by going to web-DENIS or calling PARS before providing services.

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