To be accepted into Forta’s Parent Mediated ABA Therapy, we require that your child has been diagnosed with Autism Spectrum Disorder (ASD) and a clinician concluded your child has ASD (often marked F84.0). The clinician conducting the evaluations must sign the diagnosis and can be one of the following licensed practitioners: MD, DO, PhD Psychologist, PsycD.

If you have received a diagnosis for ASD, please apply and we will work with you to ensure you have your documentation in order prior to beginning therapy with Forta.

Your child can still qualify for the program as long as the diagnoses fit within the clinical scope of the program and the main reason for seeking ABA services is for ASD.

Please have them fax it to 650-360-6969 or email to clientrecords@fortahealth.com

We recommend using a free scanner application such as Tiny Scanner or Adobe Scan for iOS or Android. We require the full report, not just select pages.

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iOS: How to scan documents on your iPhone or iPad

Android: TinyScanner or Adobe Scan

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If you have a school IEP that includes an evaluation of ASD, please apply and we will work with you to get approval from your insurance. In certain cases we may require an additional evaluation and diagnosis from your physician.

Your insurance provider does not accept school documents at this time, unless they meet the above requirements. If this changes in the future, Forta would be happy to accept alternative forms of documentation that support an ASD diagnosis.

Please have your primary care physician send a signed and dated letter to you confirming the ASD diagnosis and ICD-10 code F84.0. ICD-10 code F84.0 for Autistic disorder is a medical classification as listed by the World Health Organization (WHO) under the range - Mental, Behavioral and Neurodevelopmental disorders.

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If you are not able to acquire an updated report from your primary care physician, please let us know. Depending on your state, Forta may be able to conduct a new ASD evaluation to assist with acquiring an updated diagnosis report.

We currently are not requiring a diagnosis be dated within 5 years, but it may put your ability to gain services at risk down the line. If you are insured by a Texas Medicaid program, you will need to have a report confirming ASD dated within the last 3 years.

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Here are some actions you can begin to take to help gain ABA services:

• If a referral is required by your insurance provider, please request for the referral as soon as possible. If in an eligible state, we may also be able to assist with acquiring an updated referral or diagnosis.
• Schedule the reassessment appointment with a medical doctor or Ph.D. psychologist.
• Ask to be added to the cancellation list to receive notifications about any cancellation appointments.
• Regularly call the provider’s office to check for cancellations. It’s best to call the office thirty minutes after the office opens as the staff will have listened to any cancellation voice messages.

For ABA services to be covered, your insurance provider will need a diagnosis report written and signed by a medical doctor or phd psychologist. Authorizations and claims will not be approved without proper documentation.

• All pages of the diagnosis report must be included
• Report must include a Diagnosis of Autism Spectrum Disorder (ASD)
  • OR Code - F84.0 (299.0)* listed on document
• Signed by MD, DO, PHD Psychologist, or PsycD
• Includes a recommended level of Autism support (i.e. level 1 or mild; level 2 or moderate; level 3 or requiring substantial support)
• A recommendation for ABA therapy
• Include at least one standard psychiatric evaluation for autism.
  • Autism Diagnostic Interview-Revised [ADI]
  • Autism Diagnostic Observation Schedule [ADOS-1, ADOS-2]
  • Gilliam Autism Rating Scale [GARS] 1-2
  • Diagnostic Interview for Social and Communication Disorders [DISCO]
  • Childhood Autism Rating Scale [CARS]
  • Autism Analytica [Virtual IPM]
  • Others are accepted. Please submit the report you have available and we will review it to determine if it meets the required criteria for insurance approval.
  • Thorough Background History (medical/family/educational)
  • Developmental delays or regression
• Must be a recent report written within the last 5 years
  • *If your insurance is a Texas Medicaid program, the diagnosis date must be within the last 3 years.