ABA Prior Authorization Requirements – Subsequent PA Today's Date* MM slash DD slash YYYY Patient Name* First Last HiddenPhone*HiddenEmail* Clinic*Choose a ClinicDreamShip CenterMilestones Behavioral PediatricsTrio AcademyInsurance Company Date Current PA Expires MM slash DD slash YYYY This insurance company requires prior authorization for ABA therapy. If this patient is going to continue care, you will need to get a new prior auth on file with the insurance company that begins right after the current prior auth expires. Here are the details to help your clinic complete the prior authorization process for a subsequent prior authorization.Prior Authorization Requirements for Subsequent PAWhat information/forms does clinic need to submit to insurance company to get a subsequent/new prior authorization?Where does clinic submit the prior authorization documents?Please let us know the date when you have submitted your subsequent prior authorization documents to this insurance company. We will then confirm with the insurance company that they have received your prior authorization request, and that it is in process.Prior Authorization ApprovalHow long until clinic receives confirmation from insurance company of what care is approved?How will clinic receive confirmation from insurance company of what care is approved?Choose OneApproval letter by mailApproval letter by faxPhone call from insurance companyOtherAdditional CommentsWhen you receive your new prior authorization approval from insurance company, please upload the prior authorization approval letter to us in Teamwork. NameThis field is for validation purposes and should be left unchanged.