New Referral Instructions and Processes for Medicaid Insurance
For Applied Behavior Analysis (ABA) services we must first obtain some documentation. This includes:
- A completed and signed New Patient Information form for TIKI Inc
- This must be signed by the legal guardian
- A copy of the FRONT of the Medicaid Card
- A copy of the BACK of the Medicaid Card
- A copy of the Social Security Card
- A letter from the Medicaid Physician including their letter head and/or address and contact information, the prescribing Physician’s name, the child’s name, the child’s date of birth, the child’s Medicaid number, the diagnosis / diagnoses (is not limited to Autism Spectrum Disorder), and the indication for the need for ABA services with reasons or rationale. This MUST be signed by the prescribing Medicaid Pediatrician. It CANNOT be completed by the office manager, a nurse or even Physician Assistant.
- We have a Medicaid Prescription Form that covers all requirements that can be utilized by the Physician or can be referenced if they elect to type their own letter.
- Documentation to show Proof of Diagnosis
- Individualized Education Program (IEP)
- Evaluation by the Child’s School District
- Diagnostic Evaluation conducted by one of the following:
- Developmental Pediatrician
- Clinical Psychologist
- Child and Adolescent Psychiatrist
Once these documents have been received, we are able to conduct an eligibility check and request an Assessment authorization.
Once the Assessment authorization has been received, a team member from TIKI Inc will be in contact with you to schedule the intake / assessment session or sessions.
Once the Assessment has been completed it is submitted to eQHealth for review along with any additional paperwork or necessary documentation if ABA services are going to be requested.
ABA services will begin once we receive the authorization. The Lead BCBA will be working with you, your child, family and even extended family members, schools or other individuals deemed to be included in the treatment and training processes. Staff will collect data throughout each session, and often you will be asked to collect data or information as an ongoing requirement of treatment and evaluation. Our team works along side your team and will develop a behavior plan, training you and your individuals on methods and interventions that are function based and tailored to your environment(s). This is an ongoing and collaborative process.
Throughout the year the Assessment and Behavior Plan will be updated based on eQHealth requirements. This will include information from the prior period and overall progress or any barriers to progress, as well as upcoming recommendations, and changes to the plan based on the data.
Remember, the goal is for us to work together for the benefit of your child and family. Ultimately, we want you to “fire” us because you no longer need the assistance. This will be a process we work on together and slowly fade our presence and help. We look forward to our team joining your team!