Expert Analysis.
Clear Insight.
Confident Decisions.
Bringing extensive ABA clinical experience and specialized utilization management expertise to every review. We provide clear, policy-based analyses that equip medical directors and clinical leaders with the insight needed for sound authorization decisions.
Our Services
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Applied Behavior Analysis (ABA) services represent a significant investment for commercial payors, with treatment plans often requiring up to 40 hours per week. Ensuring these services meet medical necessity criteria requires specialized clinical expertise and thorough policy knowledge—expertise that many medical directors need but don't have readily available in-house.
We provide independent, policy-based clinical necessity reviews for ABA prior authorization requests on behalf of commercial insurance payors, including initial and concurrent review services. Our reviews are conducted by a Board Certified Behavior Analyst (BCBA) with expertise in both clinical practice and utilization management.
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Insurance Interventions created the CLEAR criteria to set our review capabilities apart from other generalized review services:
CLEAR stands for Clinical Level Evidence for ABA Review — a name that reflects our commitment to keeping clinical necessity decisions grounded in science, not administrative convenience.
WHAT CLEAR STANDS FOR
C- Clinical-Every criterion traces back to peer-reviewed literature, BACB practice guidelines, or published federal and commercial payer standards.
L- Level-We apply consistent, calibrated standards — the same framework for every case, every payer, every reviewer.
E- Evidenced-based-Our criteria are built from named, citable sources — not proprietary algorithms. We show our work.
A- ABA- Focused exclusively on Applied Behavior Analysis — the depth that comes from specialization, not generalization.
R- Review- Criteria updated annually against current literature, with every version retained and dated for full audit transparency.
BUILT FROM SOURCES YOU ALREADY TRUST
BACB Practice Guidelines; TRICARE Operations Manual Ch. 18; DSM-5-TRCASP Practice Parameters; UHC/Optum ABA Guidelines; Aetna ABA Criteria; State Medicaid standards; Peer-reviewed ABA literature
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When you contract with Insurance Interventions, your written clinical guidance/policy becomes the governing standard for every ABA review we conduct on your behalf. Our CLEAR Criteria fill the gaps where your benefit design is silent — but they never override your requirements. That's not just a policy position. It's built into our clinical criteria document, our reviewer training, and our case documentation standards.
Why Us?
ABA specialization
Every reviewer holds BCBA certification or equivalent clinical credentials in behavioral health. We review ABA and nothing else.
URAC-aligned from day one
Our policies, timeliness standards, appeals procedures, and quality management program were built to URAC Health Utilization Management accreditation requirements.
Your criteria, your standards
Our review process adapts to your medical director's written requirements — additions, modifications, or removals — documented and applied to every case we handle on your behalf.
ABA-only focus. Enterprise-grade standards.
We built Insurance Interventions to fill a specific gap: health plans that need strictly ABA clinical necessity review. Reviews are completed with real clinical depth, full documentation, and align with compliance infrastructure that enterprise contracting requires.