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Harvard Pilgrim Health CareCommercial · Prior Auth · Prior Authorization · MA, RI, NH, ME, VT · Psychiatry, PediatricsHigh impact

ABA services: authorization and accreditation updates

Act
immediately
Effective date
Not stated in the notice
Identified
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.

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What to do

immediately · 3 steps
01Update 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).
02Billing team must modify authorization request procedures in system.
03For 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).

Original notice

ABA services: authorization and accreditation updates
point32health.org · Always check the source before changing claims.
View original ↗

Related changes

See all Harvard Pilgrim Health Care changes →
ABA accreditation requirements and deadlinesHighNo effective date · Provider NewsletterClaims and authorization for ABA therapy servicesMediumNo effective date · Prior AuthorizationBrowse every Harvard Pilgrim Health Care change in the policy list

Related policy hubs

Harvard Pilgrim Health Care policiesMA policy changesRI policy changesNH policy changesME policy changesVT policy changesPsychiatryPediatrics

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ABA services: authorization & accreditation - Commercial