This Outpatient Treatment Report (OTR) is specific to the unique clinical needs of members with Autism Spectrum Disorders. The following changes and suggestions are offered to help ensure the OTR submitted is “clean”, and can be accurately read and quickly authorized.
- Services for ASD members requested on the new Autism/ABA OTR will be authorized for six (6) months, except in Virginia where services are authorized for twelve (12) months. Please be sure to request enough services to cover 12 weeks of treatment on the OTR. Also, only request contracted codes, included on your fee schedule, to avoid claims issues.
- Services requested on the OTR need to be reflected in a Comprehensive Treatment Plan that is generated by a Certified Behavior Analyst or a Licensed Mental Health Practitioner (MD, PhD, or Masters-level practitioner specializing in Autism treatment).
- An updated treatment plan must be completed every six (6) months. The most current treatment plan on file must be included with each OTR submitted. The Member name and ID number must appear on each page.
- Cover sheets are not recognized by the automated system, therefore they are discarded. If you have requests related to the authorization, please allow 2 business days for the processing of the form before calling your MHNet Customer Service Representative with the request.
- On your claim form, under “Place of Service” (line 24b), please use code 99.
- Please ensure that your fax machine is not double-feeding, and retain your fax “sent” log. There is currently no fax confirmation capability available within our process.
- As with all our OTRs, please complete all fields.
- Providers billing as an individual should use their own NPI (National Provider Identifier) and TIN (Tax ID Number) numbers.
- Providers billing under a group TIN should use their own NPI and the group’s TIN number at the top of the OTR form.