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 diagnostic 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.
-
For the states of MO and PA: If you are a professional who is licensed by your state to practice independently for
ABA services please review the minimum credentialing requirement and then proceed with completing the Online Screening
Form. Join Our Network
Group Programs/Facilities
If you are providing services as part of a group program composed of 10 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.
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