Guidelines for using Autism diagnostic evaluation results form

Members can obtain an autism evaluation using one of the methods described in the document Obtaining an autism diagnostic evaluation and finding treatment.

If you choose to record the results of the autism evaluation on the Autism diagnostic evaluation results form, follow these guidelines:

• Use only the current version of the form, which is dated Jan. 1, 2024, or later. Older versions include fax numbers that should no longer be used.
• Record the diagnosis on the form, even if it isn’t an autism diagnosis.
• Don’t fax the form. Give it to the member or to the member’s parent or guardian along with the components of the evaluation. The member gives the form and the evaluation components to the treating practitioner.

Note: We’re still receiving the older forms from approved autism evaluation centers. Faxing these forms to Blue Cross Blue Shield of Michigan and Blue Care Network — instead of giving them to the member or to the member’s parent or guardian — can delay the members from getting the treatment they need.

• If you’re the treating provider, submit the form and the evaluation components to Blue Cross Behavioral Health℠ when you request prior authorization.

We’ve updated the document Blue Cross Behavioral Health: Frequently asked questions for providers to include this information. Providers can access that document on our ereferrals.bcbsm.com website, on these pages:

• Blue Cross Autism Services
• BCN Autism Services
• Blue Cross Behavioral Health
• BCN Behavioral Health