Autism Information and Resources for Providers
According to the National Institute of Mental Health, Autism Spectrum Disorders (ASD), also known as Pervasive Developmental Disorders (PDD), cause severe and pervasive impairment in thinking, feeling, language, and the ability to relate to others. These disorders are usually first diagnosed in early childhood. CIGNA Behavioral Health's years of experience in assisting practitioners and families have shown us the importance of information, planning, resources and teamwork for the successful management of this illness. In an effort to provide these to the parents and families of children living with this disorder, CIGNA Behavioral Health has developed an educational program for Autism. This program consists of tools for parents on understanding autism and for providers on monitoring treatment progress.
Covered Services
Behavioral health services are available and covered for a variety of mental health and substance abuse problems. CIGNA Behavioral Health care management staff will compare your recommended treatment plan to established Clinical Practice Guidelines and determine if benefits are available, in accordance with standard utilization review procedures. Note: Autism services may not be covered under your patient's benefit plan. Please call the number on the back of your patient's ID card to learn more about services and specialties covered under the benefit plan.
People occasionally ask us about coverage for the following types of services related to Autism:
- Speech Therapy -- This is not covered by CIGNA Behavioral Health. You may want to check with your patient's medical carrier to see if they will cover it.
- Occupational Therapy -- This is not covered by CIGNA Behavioral Health. You may want to check with your patient's medical carrier to see if they will cover it.
The following types of services are considered to be experimental treatments for Autism and would not be covered under your patient's benefit plan:
- Biofeedback
- Hippotherapy
- Music Therapy
Definition of Medical Necessity
Health care services are considered medically necessary when they are determined by CBH to: (a) be consistent with generally accepted practice parameters as recognized by health care providers in the same or similar general specialty as typically treats or manages the diagnosis or condition; (b) help restore or maintain the person's health; (c) prevent deterioration of or palliate the person's condition; or (d) prevent the reasonably likely onset of a health problem or detect an incipient problem. Health care services shall also include diagnositc testing, preventive services, and aftercare appropriate in terms of type, amount, frequency, level, setting, and duration to the person's diagnosis or condition.
Please refer to the Level of Care Guidelines for more information on how CIGNA Behavioral Health determines medical necessity.
Authorization Process
Authorization may be required in some instances. Please call the number on the back of your patient's ID card to determine if pre-authorization is needed to complete treatment.
To determine the appropriate application process to provide autism services for CIGNA's behavioral network, please refer to the following information:
Individual Practitioners
- If you are a professional who is licensed by your state to practice independently for services other than autism (e.g. LCSW, LPC, and licensed psychologist) please review the minimum credentialing requirement and then proceed with completing the Online Screening Form. Join Our Network
- If you are a BCBA without another behavioral health license, a BCaBA, or a professional who is a part of the Pennsylvania State Medicaid Autism Program, please complete the Autism Specific Screening Form and fax to the number listed at the top of the form.
Group Programs/Facilities
If you are providing services as part of a group program composed of five (5) or more autism professionals, please have the program administrator complete the Autism Program Questionnaire and fax to the number listed at the top of the form.
|
