Banner-University Family Care — the Banner Health / University of Arizona Health Plans entry — carries the second-largest ACC footprint (ten counties, including Maricopa and Pima) plus ALTCS contracts. Unlike Mercy Care, UHC, or Arizona Complete Health, Banner publishes no distinct ABA clinical policy: everything we can verify points to the AMPM 320-S state baseline plus the plan's own ABA Prior Authorization Form. That makes this a verify-in-the-portal plan — the state guide tells you the clinical rules; Banner's portal tells you the paperwork.
Banner lists an "Applied Behavior Analysis (ABA) Prior Authorization Form" among its behavioral-health materials, which confirms treatment PA exists — but the plan publishes no ABA clinical policy, no assessment-PA rule, no authorization durations, and no hour guidance that we could verify. The honest operating assumption is the state baseline: AMPM 320-S clinical criteria (including the no-autism-dx-required rule and 6-month progress reports), with Banner's own form as the PA vehicle. Before quoting a family a start date, pull the current ABA PA form from the behavioral-health materials page at bannerhealth.com/bhpprovider and confirm directly with the plan whether assessment codes 97151/97152 require PA — the two largest Arizona plans skip it, but Banner's position isn't published.[1][2]
Banner-University Family Care operates as an ACC plan in Maricopa, Pinal, Cochise, Gila, Graham, Greenlee, La Paz, Pima, Santa Cruz, and Yuma counties, plus ALTCS in ten counties — the second-largest geographic reach after Arizona Complete Health. For intake, that means Banner cards show up across both metro Phoenix and southern Arizona; treat every one as an AMPM 320-S case with Banner-specific paperwork to confirm.[3]
The questions that decide whether a family can start with Banner-University Family Care, and what they have to bring. Each maps onto something intake should ask on the first call.
Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: AMPM 320-S sets no age bound of its own. Behavior Analysis Services are covered "for individuals with Autism Spectrum Disorder (ASD) and/or other diagnoses as justified by medical necessity," and the policy applies across ACC, ALTCS E/PD, DCS/CMDP, DES/DDD, the RBHA contracts and fee-for-service programs without an age criterion. In practice children reach the benefit through EPSDT, and nothing in the policy text excludes adults — screen on medical necessity, not birthday.[2][1]
Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: None at the state level. AMPM 320-S imposes no recency clock on the diagnostic evaluation — and no autism diagnosis at all is strictly required. What must be current is the assessment: services are "prescribed or recommended in specific dosages, frequency, intensity, and duration by a qualified BHP as the result of an assessment of the member." Plan-level overlays can be stricter, so check the per-plan guide before telling a family an old evaluation still counts.[2][1]
Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: AMPM 320-S gates on who recommends ABA, not on who diagnoses: services must be "prescribed or recommended... by a qualified BHP." A Behavioral Health Professional is defined as an individual licensed under A.R.S. Title 32, Chapter 33 whose scope allows independent behavioral health practice (or practice under direct supervision, except a licensed substance abuse technician); a psychiatrist (A.R.S. § 36-501); a psychologist (A.R.S. § 32-2061); a physician; a Behavior Analyst (A.R.S. § 32-2091); a registered nurse practitioner licensed as an adult psychiatric and mental health nurse; or a registered nurse with psychiatric-mental health certification or one year of behavioral health experience.[2][1]
Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: No single instrument is mandated. "Behavior Analysis Services shall be based upon assessment(s) that include Standardized and/or Non-standardized instruments through both direct and indirect methods." Standardized examples named in the policy: the Pervasive Developmental Disabilities Behavior Inventory, the Brigance Inventory of Early Development and the Vineland Adaptive Behavior Scales. Non-standardized examples: curriculum-referenced assessments and stimulus preference assessment procedures.[2][1]
Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: A prescription or recommendation from a qualified Behavioral Health Professional, based on an assessment of the member, is the referral — AMPM 320-S requires nothing else and sets no prior-authorization rules of its own, leaving PA to the Contractors. The two largest plans both skip PA on the assessment codes: Mercy Care states no PA is needed for 97151 and 97152, and Optum's Arizona orientation states "All ABA services require prior authorization except 97151 and 97152."[2][4][5][1]
Banner – UFC’s 2026 manual: "Medical Standard requests will be reviewed within 14 days. Medical Expedited requests will be reviewed within 72 hours of receipt," and "Extensions on expedited and standard requests can be provided if more time is needed to obtain records." ABA PA is required before services begin, faxed on Banner’s ABA PA form; no reauth lead time is published. AHCCCS’s own CY2025 prior-authorization metrics report (March 2026) says that "Beginning January 1, 2026" the CMS rule requires Medicaid managed care plans to decide within "7 calendar days for standard requests (non-urgent)" and "72 hours for expedited requests (urgent)"; the federal regulation ties the 7-day ceiling to rating periods starting on or after January 1, 2026. Confirm with Banner which clock it runs.[7][8][9]
Banner – UFC pays last: it "will require an Evidence of Benefit (EOB) or Remit Advice (RA) from a primary payer to coordinate benefits once the primary payer has adjudicated the claim" and "may further review the claim for medical necessity" on its own criteria; "If primary payor does not cover the service, B – UFC may waive the need for an EOB or RA." Cost sharing is paid up to the lesser of its fee schedule or the other payer’s allowed amount, and secondary claims are due within 60 days of the primary RA. The manual does not say whether Banner requires its own PA when secondary; AHCCCS policy (ACOM 434) bars a secondary PA only when the other insurer approved the service as medically necessary, so where the commercial plan has not approved ABA, get Banner’s PA. Under federal rules TRICARE pays before Medicaid, and CHAMPVA pays first when the child is also Medicaid-eligible.[7][10][11][12]
Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: AMPM 320-S permits telehealth delivery but does not price it: the individualized treatment plan must "identify the modality by which the service will be delivered (whether in person or via telehealth, or in-group or individual setting, or combination thereof)." Which 9715x codes are actually payable remotely, and with which place-of-service code or modifier, lives in the AHCCCS telehealth code set and the Behavioral Health Services Billing Matrix, neither of which we could retrieve at this review — azahcccs.gov returns 403 to automated fetching.[2][1]
Blocked on: Banner Health Plans at bannerhealth.com/bhpprovider — pull the current ABA Prior Authorization Form and ask the plan directly; none of this is published at plan level.
Coverage decides whether Banner-University Family Care pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: A duty with no number attached. "Behavior Analysis Services shall be directed and overseen by Behavior Analysts and supported, where applicable, by Behavior Analysis Trainees and/or Behavior Technicians." The Behavior Analyst "is responsible for all aspects of clinical direction, supervision, and provider-level case management," for training Trainees and Technicians, for ensuring that "the extent, kind, and quality" of what they deliver matches their training and experience, and for their compliance with the policy and A.R.S. § 32-2091. A Behavior Analysis Trainee needs "direct and ongoing supervision consistent with the standards set by a nationally recognized Behavior Analyst certification board." AMPM 320-S publishes no supervision percentage and no caseload cap, so for RBT-credentialed staff the BACB floor is the operative number.[2][1]
Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: The claim line has to say who actually delivered the service. AHCCCS pays credential-tiered rates through modifiers — HM below bachelor's (technician level), HN bachelor's, HO master's, HP doctoral — and AMPM 320-S points to the Behavioral Health Services Billing Matrix for "modifiers for Behavior Analysis Trainee billing." Whose NPI goes in the rendering field is set per Contractor: UnitedHealthcare Community Plan, for instance, requires the rendering provider's 10-digit NPI in box 24J, "must be an active AHCCCS registered provider (The rendering provider is the BCBA/Licensed Clinician)."[2][6][5][1]
Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: AMPM 320-S does not address whether 97153 and 97155 may be billed for the same clock time. The policy routes every coding question elsewhere: "Refer to the Behavioral Health Services Billing Matrix and Medical Coding Resources on the AHCCCS website for more information regarding required coding information, including covered settings, modifiers for Behavior Analysis Trainee billing, or other billing/coding information."[2][1]
Blocked on: Banner Health Plans at bannerhealth.com/bhpprovider — pull the current ABA Prior Authorization Form and ask the plan directly; none of this is published at plan level.
Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: No per-day unit ceiling appears in AMPM 320-S; the policy sets clinical content, not claim edits, and defers unit and coding questions to the Behavioral Health Services Billing Matrix. Dosage is set case by case — services are prescribed "in specific dosages, frequency, intensity, and duration" by the recommending BHP — so the binding ceiling in practice is the Contractor's authorization.[2][1]
Blocked on: Banner Health Plans at bannerhealth.com/bhpprovider — pull the current ABA Prior Authorization Form and ask the plan directly; none of this is published at plan level.
Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: AMPM 320-S sets a reporting cadence, not a signature rule. Progress reports are required "at minimum, every six months" and must include member identification; background information (family dynamics, school placement, cultural considerations, prenatal and/or developmental history, medical history, sensory, dietary and adaptive needs, sleep patterns, medications); assessment findings; outcomes (measurable objectives, progress toward goals, clinical recommendations, treatment dosage, family role and outcomes); and care coordination (transition statement and individualized discharge criteria). Who signs a session note, and within what window, is not stated.[2][1]
Ask the plan: Banner Health Plans at bannerhealth.com/bhpprovider — pull the current ABA Prior Authorization Form and ask the plan directly; none of this is published at plan level.
Follows the AHCCCS rule — Banner publishes no distinct ABA clinical policy, only its own ABA Prior Authorization Form: AMPM 320-S requires the treatment plan to "specify the setting(s) in which services will be delivered" but publishes no payable-setting list, pointing instead to the Behavioral Health Services Billing Matrix "regarding required coding information, including covered settings." What is documented at the rate level is that setting changes the money: the November 2023 fixed-rate notice pays home delivery (POS 12) roughly 10% above the clinic rate on every ABA code.[2][6][1]
Blocked on: Banner Health Plans at bannerhealth.com/bhpprovider — pull the current ABA Prior Authorization Form and ask the plan directly; none of this is published at plan level.
Yes — as an AHCCCS ACC plan it covers Behavior Analysis Services under AMPM 320-S. Treatment requires PA via Banner's ABA Prior Authorization Form; the plan publishes no distinct clinical policy beyond the state baseline.
Not published — unlike Mercy Care and UHC, Banner's assessment-PA position isn't stated publicly. Verify with the plan or the current PA form before booking an assessment as auth-free.
Not published. Benchmark against the AHCCCS physician fee schedule (97153 at $17.91–$23.69 per 15-minute unit by credential tier); your contract is the source of truth.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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