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Attention Applied behavior analysis (ABA) providers:
This notice provides an update to the June 2023 provider alert regarding which ABA providers must enroll with Apple Health (Medicaid) and which individual providers must be identified as servicing providers on ABA claims.
Providers who render services to Apple Health clients must be enrolled with the Health Care Authority (HCA) under the billing providers’ Core Provider Agreement (CPA) – See WAC 182-502-0005(2). All ABA providers, including Certified Behavior Technicians (CBTs) and Licensed Assistant Behavior Analysts (LABAs), must be enrolled with Apple Health as a servicing provider (also known as rendering or performing provider) and their National Provider Identifier (NPI) must be listed on claims for services provided.
Effective July 1, 2024, all CBTs and LABAs working with Apple Health clients must meet the following requirements:
- Have an active CBT or LABA license with the Department of Health (DOH)
- Have an NPI
- If part of a health care group or organization with a CPA, enroll with HCA as a servicing provider or nonbilling provider under the group’s CPA
- If applicable, be listed as a servicing provider on the group’s roster submitted to the managed care organization (MCO)
- For dates of service on and after July 1, 2024, have their NPI captured on the claim as the servicing provider for services rendered.
Additional information:
See WAC 182-502-0002 for eligible provider types.
See WAC 182-531A-0800 for ABA provider requirements.
See HCA’s Applied Behavior Analysis (ABA) Program Billing Guide.
See HCA’s Provider Enrollment webpage.
Please contact the ABA program with any questions or comments.
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