In this second part of our series on enrollment, we review the seven documents that parents will need to provide to get their child started in ABA therapy. It is the natural next step on a parent’s “to do” list after reviewing our blog: Understanding the Milestones Required to Start Early Intervention ABA Therapy. In our experience, families who gather the Diagnostic Report, ABA Referral, and Insurance Information early tend to move through the enrollment process much more quickly. This article will help you set realistic expectations around your documentation and insurance requirements, reduce enrollment frustration, and make the process much easier to navigate.
Document #1: Autism Diagnostic Report
This is usually the most important document. Most insurance companies require a copy of the full formal Autism Spectrum Disorder Diagnostic Report completed by a qualified professional. This item can be faxed to your selected ABA provider directly.
One of the most common delays occurs when the report does not contain enough information for the insurance company to approve services. This report typically includes a detailed summary of the individual’s developmental history, behavioral observations, and results from various assessments conducted by specialists such as psychologists, neurologists, or developmental pediatricians. The report may cover areas like social communication abilities, repetitive behaviors, sensory sensitivities, and cognitive functioning to help identify the level of autism observed in the child. It is important that parents understand that the summary report that some providers give to families will not be accepted by insurance.
Parents should know that getting a diagnosis is often just the first step. Depending on the insurance plan, there may still be benefit verification, document collection, clinical assessments, and authorization reviews required before services can begin. Every insurance company has slightly different requirements, which is why timelines can vary from family to family.
Document #2: ABA Referral or Order
Many insurance plans require a referral or prescription from the child’s physician recommending ABA therapy. A referral or order for ABA services is usually created by a healthcare professional, such as a pediatrician, psychologist, or psychiatrist, who determines that an individual will benefit from behavior therapy. This referral serves as a recommendation for the child to undergo an assessment at an ABA therapy provider to evaluate the child and create a customized treatment plan to be submitted to the insurance company for approval.
Requirements vary by insurance company, but missing or expired referrals can often delay the process. Insurance companies will require a referral for ABA services that is dated within a year of the authorization request that will be made by your preferred ABA provider. For most clients, this referral will be acquired from their pediatrician. This item can be faxed to your selected ABA provider directly.
Document #3: Insurance Card and Member Information
Your insurance card serves as proof of coverage under a specific insurance policy. Typically, it includes essential details such as the policyholder’s name, policy number, insurance provider’s contact information, and coverage details. Your preferred ABA therapy provider will require a copy of the insurance card to allow them to verify benefits, determine coverage, and identify any authorization requirements before services begin. A copy of the front and back of the insurance card is required to be kept on file by your ABA therapy provider. You can provide photos of the physical card or a copy from the insurance provider’s portal.
Document #4: ABA Registration Forms
The ABA therapy registration form is a document used to collect essential information from parents seeking ABA therapy services for their child. These forms help your ABA therapy provider learn about the child’s developmental history, current concerns, medical background, and family goals. The more complete the information, the smoother the assessment process tends to be.
The form includes sections to capture personal details, like the child’s name, date of birth, and contact information. Additionally, it may request information about your child’s diagnosis, medical history, and any previous therapies or interventions they have undergone. The form might also include consent sections for the release of medical records or request parent agreement to the ABA provider’s terms of service.
This form can usually be filled out electronically or in-person at your preferred ABA provider.
Document #5: Photo ID
A copy of the parent/guardian’s photo ID is required to be kept on file by your ABA provider. Providers typically request a copy of the one side of the ID that contains the parent or guardian’s photo.
A photo ID is an official document that includes a photograph of the holder and personal information like name and date of birth. Examples of photo IDs include driver’s licenses, passports, and state-issued identification cards.
Document #6: Guardianship or Custody Documents (If Applicable)
If someone other than a parent is making medical decisions for the child, legal documentation may be required before ABA services can start.
Guardianship or custody documents are legal papers that outline the rights and responsibilities of an individual or individuals towards a minor. Custody documents are often used to establish who has the legal right to care for and make decisions for a child, typically following a divorce or separation. Guardianship documents may be needed when parents are unable to care for their child. These documents are essential in ensuring that the best interests of the child are protected and legally recognized.
Document #7: Previous Evaluations or Therapy Records (If Applicable)
Speech, occupational therapy, school evaluations, IEPs, or previous ABA records can provide valuable information and help the clinical team better understand your child’s needs.
It is in the parent and child’s best interest to provide as many records as possible because they help your provider understand the wider spectrum of your child’s abilities and behaviors. Speech therapy records reveal communications abilities and challenges; occupational therapy records shed light on daily living skills, sensory processing and motor skills; while school evaluations provide a view of academic, social and behavior skills in more formal group settings. This broader view will help the ABA therapist create a more effective treatment plan.
Early Intervention ABA Therapy at Wellspring Learning Centers
At Wellspring Learning Centers, we have a team of professionals whose primary job is to help parents navigate the enrollment process efficiently and effectively. These professionals have many years of experience dealing with a wide range of family situations, medical providers, and insurance company requirements. We also have admissions professionals, clinicians, and family liaisons that are fluent in English and Spanish to ease the challenge that Hispanic families face when seeking ABA therapy for their child.
We’re proud that Nashville parents rate us 5 Stars on Google Reviews. Contact us today by filling out our online form or giving us a call at 615-236-6399 to learn how our ABA therapy services can support your child’s progress and help them reach their full potential.