According to the National Institute of Mental Health, Autism Spectrum Disorder (ASD) causes severe and pervasive impairment in thinking, feeling, language, and the ability to relate to others. This disorder is usually first diagnosed in early childhood. Our experience of working with providers and families has shown us that it’s necessary to have the right information, planning, resources and teamwork for the successful management of this illness. To best help parents and families of children living with this disorder, Evernorth Behavioral Health has developed a Coaching and Support program for autism. It includes comprehensive tools to help parents understand autism and to help providers monitor treatment progress.

Autism Resource Guide

The goal of the Autism Resource Guide is to help ease your administrative burden, so you can spend more time at the heart of your practice — providing care to your patients, and our customers. Obtaining autism-related treatment is dependent upon a patient’s specific benefits plan.

Covered Services

Behavioral health services are available and covered for a variety of mental health and substance use disorders. For more information, visit our Autism Spectrum Disorder: Assessment and Treatment Coverage Policy.

Coverage Policy

For more information about our coverage policy, please refer to Intensive Behavioral Interventions - (EN0499).

Authorization Process

Authorization may be required in some cases. 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 and/or determine if prior-authorization is required to complete treatment. Please follow the prompts to be connected to Evernorth Behavioral Health.

Please note: As of December 1, 2020, precertification is no longer required for assessment CPT codes 97151, 97152, or 0362T with a diagnosis of autism, as long as the provider is independently licensed or a Board Certified Behavior Analyst and the customer’s policy covers ABA services. If you provide ABA services, you only need to submit claims for these assessment services and they will be evaluated for payment. Claim submissions are evaluated according to industry standards. Please note that authorization is required for 97151, 97152, or 0362T when requesting a network exception.

• Patient privacy - Each time you call Evernorth, HIPAA verification will be necessary. Please be prepared with your Tax Identification Number (TIN) and the patient's:
• Name
• Date of birth
• Address
• ID number on the health benefit card
• Make a request - To request ABA treatment services or to verify ABA benefits and eligibility, please Behavioral Forms and submit the appropriate Applied Behavior Analysis Form.
• Prior authorization forms should be completed by a supervisor or the rendering health care provider on a case. If you would like to schedule a live review or have questions, call the Autism Case Coordination Team at the number below.

Join Our Network

If you are a board certified behavior analyst and/or licensed mental health provider, learn more about joining our network.

Working with Evernorth

To help you work most effectively with Evernorth Behavioral Health, here is some important contact information:

What is your need?	Contact:
Verify Applied Behavior Analysis benefits and eligibility	Call the Customer Service number on the back of the patient's health benefit card.
Request Applied Behavior Analysis prior authorization	Complete the ABA Prior Authorization Form in Behavioral Forms. If you have questions, call the Autism Care Coordinator Team at 877.279.7603.
For claims or other general questions	Call Provider Services at 800.926.2273.

For reimbursement of Applied Behavior Analysis therapies, Evernorth utilizes Current Procedural Terminology (CPT^®) codes. For more information about the best use of these codes, refer to Billing Codes for Applied Behavior Analysis.