Our Review Process

Each review includes:

• Comprehensive evaluation of submitted treatment reports and clinical documentation

• Assessment of medical necessity based on your specific commercial policy guidelines or utilizing best-practice methods.

• Clear, detailed written determination with clinical rationale

• Identification of any documentation deficiencies or policy conflicts

• Recommendations aligned with evidence-based ABA practice standards

  • Utilizing proprietary CLEAR criteria to utilize best-practice for ABA clinical necessity review includes information gathered from commercial policy documentation, CASP, state medicaid requirements, TRICARE operations manual, and other resources.

Service Commitments

• Standard turnaround: 2-3 business days

• Urgent cases: 24-hour turnaround available

• Policy-specific reviews: All determinations are made strictly according to your plan's coverage criteria, or utilizing our CLEAR criteria.

• Clinical expertise: Reviews conducted by a BCBA with 11 years of ABA clinical experience and 5 years of clinical necessity review expertise

• Peer-to-Peer Calls: Upon request, calls can be made to providers to obtain more information for determination