CommercialPrior AuthHigh impact
ABA services: authorization and accreditation updates
Harvard Pilgrim Health Care·MA, RI, NH, ME, VT · Psychiatry, Pediatrics·Prior Authorization
We identified it
Jun 20, 2026
Summary
Point32Health (Harvard Pilgrim and Tufts Health Plan) has changed ABA therapy prior authorization requirements - providers must now use practice NPI (Type 2) instead of individual therapist NPI when submitting authorization requests. Additionally, accreditation deadlines have been extended for center-based ABA providers in New Hampshire, Maine, and Vermont to January 1, 2028.
Action Required
Immediately: Update ABA therapy prior authorization submission process to use practice billing NPI (Type 2) instead of individual therapist NPI for all Point32Health members (Harvard Pilgrim and Tufts Health Plan). Billing team must modify authorization request procedures in system. For center-based ABA providers: ensure accreditation compliance by January 1, 2027 (Massachusetts and Rhode Island) or January 1, 2028 (New Hampshire, Maine, Vermont, and all other providers).