Ambetter ABA Therapy PA requirements effective 6/1/26

Date: 05/12/26

Ambetter from Arkansas Health & Wellness requires prior authorization as a condition of payment for many services. This notice contains information regarding such requirements and is applicable to all Marketplace products offered by Ambetter Health.  

We are committed to delivering cost-effective, quality care to our members. As such, we want to make sure our members receive only treatments that have been deemed medically necessary by current standards of practice. Prior authorization allows us to verify the medical necessity of a treatment in advance, using independent, objective medical criteria and/or in-network utilization where applicable.  

The prior authorization process is initiated by the physician, and it is the ordering/prescribing provider’s responsibility to determine which codes require prior authorization. Please verify eligibility and benefits prior to rendering services to patients. Payment, regardless of authorization, is contingent on the member’s eligibility at the time the service is rendered. Nonparticipating providers and facilities require authorization for all services except where otherwise indicated.  

 For a complete listing of current CPT®/HCPCS billing codes, use our online Pre-Auth Check tool. Visit AmbetterHealth.com/ar, select For Providers, and then select Pre-Auth Check from the drop-down menu. 

Enclosed is a table detailing upcoming changes to our prior authorization requirements. These changes are effective June 1, 2026.