TRICARE Frequently Asked Questions
- How do I start with ACES?
- How do I start ABA with TRICARE/Humana Insurance?
- How do I get a Referral for ABA?
- What are Outcome Measures?
- What's the difference between a referral and an authorization?
- TRICARE approved an authorization for another provider. How can I get it switched?
- How can I contact TRICARE/Humana?
- Common Autism Abbreviations
How do I start ABA with TRICARE/ Humana Insurance?
You must receive a formal Diagnosis from your Primary Care Physician (PCP) or Primary Care Manager (PCM) from TRICARE. TRICARE would need to approve ABA Authorization to the provider.Return to Menu
How do I get a Referral for ABA?
Primary Care Physician (PCP) or Primary Care Manager (PCM) will need to initiate the referral to TRICARE. We highly recommend confirming with your PCP or PCM that the referral was submitted to TRICARE. Once TRICARE receives referral, they will begin provider placement and approve an ABA Authorization.Return to Menu
Tricare Outcome Measures
Tricare requires Outcome Measures to be completed in order to process your child's treatment authorization requests. Outcome Measures (OMs) are a set of parent surveys that will provide Tricare with insight about the child and family while focusing on patient improvement or regression. Please note that OMs and ABA services are not the same, this means your child may be authorized to a provider who is not their ABA provider. You and your child's provider team must complete the following baseline measures:
Pervasive Developmental Disorder Behavior Inventory (PDDBI, 2 years–18.5 years, but can accept as early as 1.5 years),
Vineland Adaptive Behavior Scales, Third Edition (Vineland-3, 0 years–90 years, renewed annually)
Social Responsiveness Scale, Second Edition (SRS-2, 2.5 years–99 years, renewed annually)
How to Complete OMs with ACES
If your child was authorized to receive both ABA and OMs at ACES, our team will coordinate with Tricare and our treatment team to complete these measures with you around the time of assessment. The following form is required to begin the intake process:
If you were only authorized to receive OMs with ACES, we will need the following forms to be submitted. Please select "TRICARE client: I am only seeking outcome measures" in our New Client Application Form:
If you were only authorized to receive OMs with ACES but are interested in our ABA services as well, the above forms (a and b) are still required. We encourage you to mark "Yes" when asked "Are you interested in starting ABA services with ACES?" In our Tricare Outcome Measures form. Our Tricare Care Coordinators will then reach out with more information.
Tricare Resource: Outcome Measures (tricare-west.com)
TRICARE approved an authorization for another provider. How can I get it switched?
Complete ACES Onboarding application and a TRICARE Client Care Coordinator can assist with how to switch over an Authorization.
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Common Autism Abbreviations
- ASD: Autism Spectrum Disorder
- ASN: Autistic Self Advocacy Network
- PCM: Primary Care Manager
- PCP: Primary Care Provider
- ECHO: Extended Healthcare Option
- EMFP: Autism Behavioral Health Resources for Military Families
- CCP: Comprehensive Care Plan
- Accolade: An independent health benefits navigator who American has partnered with to help you navigate the health care system, your health decisions and your health benefits in a way that is personalized to you.
- DSM-5: Diagnostic and Statistical Manual of Mental Disorders, Fith Edition
- OM: Outcome Measures
- HNFS: Health Net Federal Services