---
title: "Blue Cross of Idaho ABA coverage: the intake guide."
url: "https://carelu.com/payers/blue-cross-of-idaho"
markdown_url: "https://carelu.com/payers/blue-cross-of-idaho.md"
state: ID (Idaho)
payer: Blue Cross of Idaho
kind: Commercial insurance
description: "How Blue Cross of Idaho handles ABA: prior authorization listed for Federal Employee Program members only, no published commercial ABA medical policy, Idaho’s Bulletin 18-02 in place of an autism statute, and what intake must verify group by group."
last_reviewed: September 2026
---

# Blue Cross of Idaho ABA coverage: the intake guide.

_Payer Guide · Blue Cross of Idaho · Last updated September 2026 · 9 primary sources_

> Idaho’s largest local carrier: no published commercial ABA policy, ABA PA listed for FEP only, Bulletin 18-02 as the coverage floor.

Blue Cross of Idaho is the state’s home Blue plan and the card an Idaho intake team sees most often. It is also the least documented carrier in this guide for ABA. We searched BCI’s provider site and found no commercial ABA medical policy. Its behavioral health prior-authorization policy (PAP902, revised April 2026) lists ABA as requiring prior authorization only for Federal Employee Program members. For everyone else, the group’s own benefit design and Idaho’s Bulletin 18-02 decide the answer. That makes benefits verification the whole job with a BCI card.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment** _(plan-dependent)_: Not listed for commercial members — PAP902 names ABA as requiring PA "for Federal Employee Program (FEP)" only; group and ASC plans may adopt none, some or all of BCI’s behavioral health management program [1]
  - Ask the plan: Blue Cross of Idaho’s Prior Authorization Procedure Code Lookup tool on providers.bcidaho.com, or customer service on the member card — ask whether this group requires PA for 97151 and treatment codes.
- **Prior auth for treatment** _(plan-dependent)_: FEP: required, 6-month authorizations on form 12-302 (InterQual criteria). Commercial: not listed in PAP902; group-specific [1][3]
  - Ask the plan: Blue Cross of Idaho Prior Authorization Procedure Code Lookup tool, or the online benefit summary for the member’s group; BCI does not accept retrospective authorizations, so check before the first session.
- **Autism diagnosis required?**: Yes for the Bulletin 18-02 coverage floor — treatment for an individual "diagnosed with an autism spectrum disorder," prescribed by a licensed physician or psychologist; BCI publishes no commercial ABA criteria of its own [5][1]

## At a glance

- **Covers ABA?:** On state-regulated plans with rehab/habilitative benefits, yes under Bulletin 18-02; self-funded groups set their own terms
- **State mandate:** No autism statute — Idaho DOI Bulletin No. 18-02 (2018) requires ASD treatment on state-regulated plans that cover rehabilitative or habilitative services (plan years from 1/1/2019)
- **Mandate age:** None — the bulletin sets no age limit
- **Mandate caps:** None separate — no separate dollar or visit limits; cost-sharing in parity with other mental health and med/surg benefits
- **Exempt from mandate:** Self-funded employer (ERISA) plans Idaho does not regulate; plans with no rehabilitative/habilitative benefit fall outside the bulletin’s trigger
- **Licensure:** None — Idaho has no behavior-analyst licensure law; BACB certification governs
- **Prior auth:** Listed for FEP only (PAP902); commercial groups vary — check the PA lookup tool

## What Blue Cross of Idaho publishes, and what it does not

BCI’s Provider Administrative Policy PAP902 lists the behavioral health services that need prior authorization. ABA appears only as "Applied behavioral analysis (ABA) - requires PA for Federal Employee Program (FEP)," and "Requests for ABA for FEP members must meet medical necessity criteria as outlined in the InterQual criteria." The same policy warns that "Blue Cross of Idaho groups and ASC policy holders may accept all, some, or none of Blue Cross of Idaho`s Behavioral Health Management program." Its mental-health coverage policy, MP 3.01.501, does not mention ABA. Its only ABA authorization forms on the provider site are marked "Federal Employee Program Only." The FEP form approves "a 6 month period" and says "ABA Service Provided within an Educational Facility is a contract exclusion and not covered." [1][2][3][4]

The practical consequence is simple. For a BCI commercial member, no public BCI document tells you whether ABA needs authorization or what the clinical criteria are, so check the group every time. PAP241 adds two BCI-wide rules that bite if you guess wrong: "Blue Cross of Idaho does not accept requests for retrospective authorizations," and elective requests "must be submitted at least 14 days prior to the scheduled date of service." [1][2][3][4]

## The Idaho coverage floor: Bulletin 18-02, not a statute

Idaho is one of the few states with no autism insurance statute, and intake should say so plainly. What Idaho has instead is Department of Insurance Bulletin No. 18-02 (April 2, 2018). Reading the federal Mental Health Parity and Addiction Equity Act, ACA § 1557 and the state’s Essential Health Benefits together, the Department declared that it "will consider an exclusion of treatments for autism spectrum disorder as discriminatory and prohibited when a plan includes coverage of rehabilitative or habilitative services, such as coverage of occupational therapy or speech therapy." It applies to the individual, small-group and large-group insured markets, and to self-funded plans subject to Idaho Code title 41, chapters 40 or 41, for plan years starting on or after January 1, 2019. Covered treatment must be "consistent with other mental health services (including applicable deductibles, copayments, or coinsurance), not subject to any separate dollar limits or visit limits, and in parity with medical and surgical benefits." The bulletin defines treatment as "evidence-based care and related equipment prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist who determines the care to be medically necessary, including but not limited to behavioral health treatment" — it does not name ABA by name, and it sets no age limit. Carriers may still review medical necessity and "periodically review the medical necessity of continuing" treatment. Two practical limits: a bulletin is weaker than a statute, and a self-funded employer plan the Department does not regulate (most ERISA plans) sits outside it entirely — plan funding type is the first fact to establish. [5]

## Licensure & rates in Idaho

Idaho has no behavior-analyst licensure law. It does not appear on the BACB’s list of states that license or regulate behavior analysts, so BACB certification is the working credential. Blue Cross of Idaho publishes no ABA fee schedule, and commercial rates are negotiated in your provider agreement. Idaho Medicaid’s published CHIS rates are a weak benchmark, because they use H-codes rather than the 97-series. [6]

## Intake gates

The questions that decide whether a family can start with Blue Cross of Idaho, and what they have to bring.

- **Referral required?**: BCI requires no separate referral for ABA in any public document. The coverage floor, Bulletin 18-02, covers treatment "prescribed or ordered" by a licensed physician or psychologist, so get a written prescription. [5][1]
- **Age limit** _(plan-dependent)_: No age limit in any BCI document or in Bulletin 18-02, which sets none. A self-funded group may write its own age terms. [5][1]
  - Ask the plan: Benefits verification — establish fully insured vs. self-funded, then the plan’s age terms.
- **Who may diagnose** _(plan-dependent)_: Bulletin 18-02 frames covered treatment as care "prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist." BCI publishes no narrower commercial list. [5]
  - Ask the plan: Blue Cross of Idaho behavioral health — confirm which diagnosing credentials the group accepts.
- **Prior-auth decision time** _(plan-dependent)_: Turns on how the plan is funded. Idaho’s Managed Care Reform Act requires a managed care organization to "respond to member or provider requests for prior authorization of a nonemergency service within two (2) business days after complete member medical information is provided," "unless exceptional circumstances warrant a longer period," and makes an obtained approval final once the service is provided, except for fraud, nonpayment or loss of eligibility (Idaho Code § 41-3930). Self-funded ERISA plans follow 29 CFR 2560.503-1: pre-service decisions "not later than 15 days after receipt of the claim," one 15-day extension, and urgent claims within 72 hours. BCI asks for elective requests "at least 14 days prior to the scheduled date of service" and accepts no retrospective authorizations. [7][8][2]
  - Ask the plan: At benefits verification ask whether the plan is fully insured or self-funded, then confirm BCI’s turnaround for this group.
- **Other insurance (who pays first)** _(plan-dependent)_: For a child on two parents’ plans, Idaho’s coordination-of-benefits rule (IDAPA 18.04.14.022) makes "the plan of the parent whose birthday falls earlier in the calendar year" primary, with separate court-decree and custody rules for parents who are not living together. Self-funded plans follow their own documents. If the child also has Idaho Medicaid, this plan pays first because Medicaid is the payer of last resort. Get BCI’s authorization anyway, since Medicaid needs the primary’s determination, and remember Medicaid pays CHIS on H-codes. TRICARE pays after this plan (10 U.S.C. 1079(i)(1)), and CHAMPVA is the last payer (38 CFR 17.270). [9][10][11][12]
  - Ask the plan: Ask Blue Cross of Idaho at benefits verification for the coordination-of-benefits order on file, and record every other coverage the child has.
- **Diagnosis recency** _(licensed criteria)_: BCI publishes no commercial rule on how recent the diagnosis must be. FEP requests use InterQual criteria, which are not public. [1]
  - In licensed criteria: Blue Cross of Idaho behavioral health review — ask whether a diagnostic report of a given age is accepted.
- **Diagnostic tools required** _(licensed criteria)_: No instrument requirement is published by BCI for commercial ABA. FEP reviews apply InterQual criteria. [1]
  - In licensed criteria: Blue Cross of Idaho behavioral health review line (208-331-7535).
- **Telehealth** _(ask the plan)_: Not addressed for ABA in any public BCI document. [1]
  - Ask the plan: Blue Cross of Idaho customer service or Provider Relations — ask which ABA codes are payable by telehealth on this group and with which POS and modifier.

## Delivery and billing rules

Coverage decides whether Blue Cross of Idaho pays. These decide whether the claim survives: staffing and supervision, concurrent billing, per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.

- **Daily limits / MUEs** _(plan-dependent)_: No per-day or per-week ABA cap is published for commercial members. Bulletin 18-02 bars "any separate dollar limits or visit limits" on autism treatment in state-regulated plans. On the FEP form BCI approves ABA in 6-month periods by requested units. [5][3]
  - Ask the plan: Benefits verification on the member ID — ask for any hour or unit limits in this group’s behavioral health benefit.
- **Place of service** _(plan-dependent)_: For FEP members, "ABA Service Provided within an Educational Facility is a contract exclusion and not covered." Commercial settings are group-specific. No public BCI commercial ABA policy restricts setting. [3]
  - Ask the plan: Benefits verification — ask whether home, clinic, community and school settings are covered for ABA on this group.
- **Supervision** _(licensed criteria)_: No commercial ABA supervision standard is published by Blue Cross of Idaho. The FEP-only request form asks providers to attest to qualifications such as the case being supervised by a state-licensed or Board Certified Behavior Analyst, and to their planned supervision frequency, but the clinical rules behind it are InterQual criteria, which are licensed and not public. [3][1]
  - In licensed criteria: Blue Cross of Idaho behavioral health (208-331-7535 / 800-743-1871) or the provider agreement — ask what supervision ratio BCI applies to ABA for this group; for FEP, the InterQual ABA criteria apply.
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed in any public Blue Cross of Idaho document we could find. [1]
  - Ask the plan: Blue Cross of Idaho Provider Relations or the provider agreement — ask whether 97153 and 97155 may be billed for the same clock time.
- **Session-note signature** _(ask the plan)_: Not addressed in any public Blue Cross of Idaho ABA document. [1]
  - Ask the plan: The Blue Cross of Idaho provider agreement and documentation standards in the Provider Administrative Policies.
- **Bill as provider** _(ask the plan)_: Not published for commercial ABA. The FEP form collects a "BCBA Provider and Contact Number" and asks whether all direct treatment providers are credentialed for independent practice of ABA. [3]
  - Ask the plan: Blue Cross of Idaho Provider Relations — ask whether technician-delivered 97153 is billed under the supervising BCBA’s NPI and which credentials BCI enrolls.

## What intake should collect for Blue Cross of Idaho

- **Plan funding type and group:** Fully insured (Bulletin 18-02 applies) or self-funded. BCI says groups and ASC policy holders may adopt none, some or all of its behavioral health management.
- **FEP or not:** FEP members need PA on form 12-302 under InterQual criteria, with 6-month approvals and no ABA in educational facilities.
- **Member ID + card photo:** Run the PA procedure-code lookup and a benefits check before the first session. BCI accepts no retrospective authorizations.
- **Diagnosis and prescription:** Bulletin 18-02 keys coverage to care "prescribed or ordered" by a licensed physician or psychologist for a child diagnosed with ASD.
- **Other coverage:** Medicaid (CHIS), TRICARE or a second parent’s plan changes the billing order. Idaho uses the birthday rule for children on two parents’ plans.

Free verification-call checklist (PDF): https://carelu.com/downloads/aba-verification-call-checklist.pdf

## Common questions

### Does Blue Cross of Idaho cover ABA therapy?

On state-regulated plans that cover rehabilitative or habilitative services, Idaho’s Bulletin 18-02 bars excluding autism treatment. Self-funded groups set their own terms. BCI publishes no commercial ABA medical policy, so verify the member’s group every time.

### Does Blue Cross of Idaho require prior authorization for ABA?

Its behavioral health PA policy (PAP902) lists ABA as requiring PA for Federal Employee Program members, with InterQual criteria and 6-month approvals. For commercial groups it is group-specific. Check BCI’s PA procedure-code lookup, because BCI does not accept retrospective authorizations.

### Does Idaho have an autism insurance mandate?

Not by statute. Idaho relies on Department of Insurance Bulletin No. 18-02 (2018), which treats an autism-treatment exclusion as prohibited discrimination when a plan covers rehabilitative or habilitative services, and bars separate dollar or visit limits.

## Primary sources

1. [Blue Cross of Idaho PAP902 — Behavioral Health Prior Authorization Requirements (revised April 2026)](https://providers.bcidaho.com/policies-and-procedures/pap/pap902.page)
2. [Blue Cross of Idaho PAP241 — Prior Authorization Requirements (revised April 2026)](https://providers.bcidaho.com/policies-and-procedures/pap/pap241.page)
3. [Blue Cross of Idaho — Federal Employee Program Only: ABA Initial Authorization form 12-302](https://providers.bcidaho.com/resources/pdfs/medical-management/behavioral-health/Applied-Behavior-Analysis.pdf)
4. [Blue Cross of Idaho MP 3.01.501 — Guidelines for Coverage of Mental Health and Substance-Related and Addictive Disorders (eff. 8/28/2025)](https://providers.bcidaho.com/resources/pdfs/medical-management/Medical%20Policy%20PDF/3%20-%20MH/03.01.501_08-28-25.pdf)
5. [Idaho Department of Insurance — Bulletin No. 18-02, Clarification Regarding Coverage of Treatments for Autism Spectrum Disorder (April 2, 2018)](https://doi.idaho.gov/bulletin/18-02-clarification-regarding-coverage-of-treatments-for-autism-spectrum-disorder/)
6. [BACB — U.S. Licensure of Behavior Analysts (Idaho not listed; map updated June 2026)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
7. [Idaho Code § 41-3930 — Managed care utilization management program requirements](https://legislature.idaho.gov/statutesrules/idstat/Title41/T41CH39/SECT41-3930/)
8. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
9. [IDAPA 18.04.14 — Coordination of Benefits (Idaho Department of Insurance)](https://proddfmmainsa.blob.core.windows.net/dfm-admin-website/rules/current/18/180414.pdf)
10. [Idaho Medicaid Provider Handbook — General Information and Requirements for Providers (December 23, 2025)](https://www.idmedicaid.com/General%20Information/General%20Information%20and%20Requirements%20for%20Providers.pdf)
11. [10 U.S.C. 1079(i)(1) — TRICARE pays after other coverage except Medicaid](https://www.govinfo.gov/content/pkg/USCODE-2023-title10/html/USCODE-2023-title10-subtitleA-partII-chap55-sec1079.htm)
12. [38 CFR 17.270 — CHAMPVA is the last payer](https://www.ecfr.gov/current/title-38/section-17.270)

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.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.