Applied behavior analysis (ABA) - Provider enrollment requirements

Washington State Health Care Authority sent this bulletin at 04/12/2023 09:31 AM PDT

Apple Health (Medicaid) Provider Alert

Attention Applied behavior analysis (ABA) providers:

The purpose of this notice is to clarify 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 under the billing provider’s Core Provider Agreement (CPA) - See WAC 182-502-0005(2). Certified behavior technicians (CBTs) 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.

Example:

If a CBT provides direct ABA services to a client under CPT® code 97153, adaptive behavior treatment by technician, the CBT’s NPI must be listed on the claim as the servicing provider. The supervising licensed behavior analyst’s (LBA) NPI is only listed on the claim when they provide direct services.

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.

Please contact the ABA program with any questions or comments.

About the Health Care Authority (HCA)

The Washington State Health Care Authority (HCA) is committed to whole-person care, integrating physical health and behavioral health services for better results and healthier residents.

HCA purchases health care for more than 2.5 million Washington residents through Apple Health (Medicaid), the Public Employees Benefits Board (PEBB) Program, the School Employees Benefits Board (SEBB) Program, and the COFA Islander Health Care Program. As the largest health care purchaser in the state, we lead the effort to transform health care, helping ensure Washington residents have access to better health and better care at a lower cost.

Please do not reply directly to this message. For more information, visit the HCA website, where you'll also find contact information.

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The Washington State Health Care Authority (HCA) complies with all applicable federal and Washington state civil rights laws and is committed to providing equal access to our services. Visit HCA’s website to view complete nondiscrimination statements.

Applied behavior analysis (ABA) - Provider enrollment requirements

Apple Health (Medicaid) Provider Alert

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About the Health Care Authority (HCA)

Disclosure notice

Nondiscrimination