Updated Medical Necessity Review Criteria for Applied Behavior Analysis (ABA) Services Effective June 1, 2025

Date: 05/01/25

Updated Medical Necessity Review Criteria for Applied Behavior Analysis (ABA) Services Effective June 1, 2025

Effective June 1, 2025, Arizona Complete Health and its affiliates will begin using the Centene Corporation Clinical Policy Applied Behavior Analysis CP.BH.104 to complete medical necessity reviews for Applied Behavior Analysis (ABA) services for all lines of business, i.e., Medicaid, Marketplace and Medicare. Prior to June 1, 2025, InterQual is utilized to complete these reviews.

We also recommend review of CP.BH.105 Applied Behavior Analysis Documentation Requirements for an outline of recommended documentation to include with your prior authorization request to justify medical necessity.

Both policies are available on the Arizona Complete Health website at www.azcompletehealth.com > For Providers > Provider Resources > Clinical & Payment Policies.

Prior authorization requests for ABA may be submitted electronically (Preferred) via our secure provider portal or Availity, or via fax 844-918-1192.

·     AZ Complete Health portal log page: https://www.azcompletehealth.com/providers/login.html

·     Availity log on page: https://apps.availity.com/web/onboarding/availity-fr-ui/#/login

If you have questions, please contact your Provider Engagement Specialist. If you need your assigned Provider Engagement Specialist’s contact information, please email us at AzCHProviderEngagement@azcompletehealth.com.