Liaison for autism spectrum disorders treatment benefits

(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 services; (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.