Prior authorization request form Form

Questions? Please call the Alliance Provider Services Department Monday – Friday, 7:30 am – 5 pm Phone Number: 1.510.747.4510 www.alamedaalliance.org BHPRVDRABA FORM NOTICE 03/2025 FAXED 03/28/2025 Important Update: New Applied Behavior Analysis (ABA) Treatment Plan Form for Behavioral Health Providers Alameda Alliance for Health (Alliance) values our dedicated provider partner community. We have an important update to share with you. We created a new Applied Behavior Analysis (ABA) Treatment Plan Form for behavioral health providers that now is available in our Alliance Provider Portal. We are excited to work with you directly and offer important training information in using the new form. While the new form is currently available for Alliance contracted ABA providers on the Provider Portal, it won’t be required until providers have received all training information. The new form will replace the existing prior authorization request form and will help serve as a treatment plan template, include the field elements required in a treatment plan, and allow attachments to better ensure efficient reviews.
Please see below to access resources that help guide you on these changes: • BHT Form Provider Training Video: https://youtu.be/yPZ5jNUp5Yw • BHT Form Training Slide Deck: www.alamedaalliance.org/providers/provider- resources/training-and-technical-assistance-opportunities There is no limit to the number of providers who can request access to our Alliance Provider Portal.
The new form must be completed by the Board-Certified Behavior Analyst (BCBA)/licensed clinician in the case who is working with the member. The clinician can save a working draft of the form for a total of seven (7) days prior to the final submission of the form.
The Alliance will hold open office hours in April and May 2025 and share invitations for dates and times. We encourage ABA providers to begin using the new form and bring any questions they may have to the open office hours.
Thank you for partnering with the Alliance in providing the high quality care and services our members deserve.