Blue Cross and Blue Shield of North Carolina (Blue Cross NC) will be requiring prior authorization for Autism treatment services for all commercial plans that provide a benefit as of January 1, 2022. Failure to have prior authorization in place for services rendered on or after January 1st, will result in a claim denial.

If you are providing Applied Behavioral Analysis (ABA) services to commercial members, the attached form can be completed and returned to Blue Cross NC to assist with ensuring authorizations are in place for January 1st. This form will allow Blue Cross NC to provide you with a written notification of the applicable authorization decision that will be effective January 1st.This process applies to members currently in treatment; any new members will require a separate request via usual authorization submission channels (fax, phone, Blue E).  

Beacon Health Options and the State Health Plan: Please also note, Blue Cross NC will be in-sourcing Behavioral Health services for our State Health Plan (SHP) members from Beacon Health Options effective January 1, 2022.  Prior authorization is and will remain a requirement for Autism Treatment services for SHP members. Upon expiration of the current authorization on file provided by Beacon Health Options, providers will be required to obtain a new authorization from Blue Cross NC prior to rendering additional services. 

Please complete this form for all members under your care and return no later than December 21, 2021. We want to ensure there is an authorization in place prior to the effective date and to prevent any impact on members. The form can be returned to BehavioralHealth@bcbsnc.com along with any questions you may have.

The criteria form for SHP and all other new members can be found on the Request Prior Plan Approval page for submission at any time.