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CommercialPrior AuthMedium impact

Claims and authorization for ABA therapy services

Harvard Pilgrim Health Care·Psychiatry, Pediatrics·Prior Authorization
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply
—

Summary

Point32Health (Harvard Pilgrim and Tufts Health Plan) has updated NPI submission requirements for ABA therapy prior authorization requests. Tufts members require practice NPI (Type 2), while Harvard Pilgrim requirements vary by provider type - clinics use facility NPI (Type 2) and provider groups use individual therapist NPI (Type 1).

Action Required

Action needed
Immediately: Update ABA therapy prior authorization submission procedures based on plan type. For Tufts Health Plan members: submit requests using practice NPI (Type 2). For Harvard Pilgrim members: clinics use facility/group NPI (Type 2), provider groups use individual ABA therapist NPI (Type 1). Train billing staff on plan-specific NPI requirements to ensure proper claim matching.

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