(1) An insurer offering a health benefit plan that provides benefits for the treatment
of autism spectrum disorders shall make available to members a liaison to facilitate
communication between the member and the insurer.
(2) The responsibilities of the liaison shall include but not be limited to:
(a) Explaining to the member the benefits for the treatment of autism under the member's
health benefit plan and the specific process to access those benefits;
(b) Explaining to the member the process for prior authorization of treatment, including
communicating specific documentation needed from the member or provider for the insurer
to consider the request;
(c) Monitoring the adjudication of the member's claims for the treatment of autism
(d) Explaining to the member the proper coding to use when submitting claims for applied
behavioral analysis therapy and any supporting documentation required to be attached
to the claim;
(e) Explaining to the member, upon request, how claims for the treatment of autism
services were adjudicated, including the application of any deductibles, copayments,
coinsurance, and benefit limitations; and
(f) Explaining to the member, upon request, any appeal rights the member may have
regarding coverage for the treatment of autism that has been denied or limited.
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