---
title: BlueCare Tennessee ABA coverage (TennCare MCO).
url: "https://carelu.com/payers/bluecare-tennessee"
markdown_url: "https://carelu.com/payers/bluecare-tennessee.md"
state: TN (Tennessee)
payer: BlueCare Tennessee (BCBST)
kind: Medicaid managed care plan (MCO)
parent_program: TennCare
description: "How BlueCare Tennessee (BCBST) administers TennCare's ABA benefit — the shared tri-MCO program description, the universal request form via Availity, BlueCare's supplemental initiation/continuation form, and 7-day UM timelines."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# BlueCare Tennessee ABA coverage (TennCare MCO).

_Payer Guide · BlueCare Tennessee · Last updated September 2026 · 7 primary sources_

> Shared TennCare program via Availity/BCBST; 26-week auths, 7-day UM decisions.

BlueCare Tennessee (including TennCareSelect), run by BlueCross BlueShield of Tennessee, administers the TennCare ABA benefit under the shared tri-MCO program description — so the clinical rules match the TennCare baseline exactly. What's BlueCare-specific is the machinery: Availity submission, BlueCare's own supplemental initiation/continuation form, dedicated fax lines, and a 7-day standard UM clock.

This plan administers the **TennCare** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [TennCare (Tennessee Medicaid) guide](https://carelu.com/payers/tenncare-tennessee-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — Universal ABA Request Form (diagnostic report + doctor's order) via Availity or fax (800) 292-5311 [3][7][6]
- **Prior auth for treatment**: Required — 26-week periods; continuation shows progress, severity levels, and hours approved vs. used [2][6]
- **Autism diagnosis required?**: ASD or another qualifying DSM-5-TR diagnosis — not strictly autism-only [6][7]

## At a glance

- **Plan type:** TennCare MCO (BlueCross BlueShield of TN; incl. TennCareSelect)
- **Clinical rules:** Shared tri-MCO ABA program description (TennCare baseline)
- **Prior auth:** Required — universal form + BlueCare initiation/continuation form
- **Auth periods:** 26 weeks / 6 months; continuation shows approved vs. used hours
- **UM timeline:** Standard decisions within 7 calendar days of receipt (since 1/1/2026); expedited within 72 hours
- **Rates:** Negotiated per contract — no published ABA fee schedule

## How BlueCare administers the benefit

Submissions run through Availity (or via provider.bcbst.com), with fax as the fallback — (800) 292-5311 for BlueCare/TennCareSelect and (800) 851-2491 for CoverKids. The assessment PA uses the universal tri-MCO request form with the diagnostic report and doctor's order attached; treatment requests add BlueCare's supplemental "Initiation and Continuation of ABA Therapy" form (rev. 2/26), which asks for the diagnosis with severity level (1–3), measurable progress, requested hours per week per code, and — at continuation — whether progress would hold if hours were reduced. UM questions go to the in-house behavioral team (BHABA@bcbst.com or (423) 535-5717, option 2). [2][3]

## What's worth knowing at intake

Authorized ABA hours are not inclusive of other services — the form explicitly separates OT/PT — so map the family's full therapy schedule without fear of crowding out the ABA request. Standard (non-urgent) authorization decisions are due within 7 calendar days: BlueCare's July 2026 manual commits to "State-established timeframes that may not exceed 7 calendar days following the receipt of the request for service" (expedited: "no later than 72 hours"), matching the TennCare contract's 7-day rule effective January 1, 2026. That is the number to set family expectations against. The older tri-MCO overview (Sept 2024) quoted 14 days; retrospective reviews it put at 30. And like all TennCare MCOs, continuation requests must account for authorized-versus-used hours, making honest availability capture at intake a six-months-later safeguard. [1][8][4]

## Intake gates

The questions that decide whether a family can start with BlueCare Tennessee (BCBST), and what they have to bring.

- **Age limit**: Follows the TennCare rule: EPSDT covers “children from birth through age 20 who have TennCare,” and the shared tri-MCO program description adds no age floor or ceiling of its own. BlueCare publishes no deviating age rule — its own initiation/continuation form collects date of birth without an age gate. [5][6][2]
- **Diagnosis recency**: Follows the TennCare rule: no recency limit on the ASD diagnosis itself, with functional re-evaluation by standardized tools expected “at least every two years.” BlueCare’s own forms ask for “Initial/First Date ASD Diagnosed” and for diagnostic confirmation — “diagnostic reports, doctor’s orders, etc.” — plus the DSM severity level (Level 1/2/3), but set no maximum age on the report. Continuation requests are due at least once every six months. [6][2][7]
- **Who may diagnose**: Follows the TennCare rule: the diagnosis must be issued by “a qualified health professional, practicing within their scope, with training in assessment of individuals with ASD and/or other neurodevelopmental concerns,” with a TN-licensed clinician documenting medical necessity. BlueCare’s forms ask only for diagnostic confirmation and severity level and name no additional credential of their own. [6][7]
- **Diagnostic tools required**: Follows the TennCare rule — no named instrument is required; the diagnosis must be validated by a documented comprehensive assessment against DSM-5-TR criteria, and the ABA assessment must include direct observation, file review, informant interviews and standardized assessments across cognition, communication, social, adaptive and behavioral domains. BlueCare adds a severity checkbox (Level 1/2/3) and, at continuation, asks for measurable goals and evidence of progress rather than a named test battery. [6][2][7]
- **Referral required?**: Follows the TennCare rule: the assessment request needs the diagnostic report and a doctor’s order. Both BlueCare forms ask for “diagnostic confirmation like diagnostic reports, doctor’s orders, etc.” BlueCare-specific mechanics: submit through Availity (Tennessee providers) or Cohere (out-of-state), with fax fallback to (800) 292-5311 for BlueCare/TennCareSelect and (800) 851-2491 for CoverKids; UM questions go to BHABA@bcbst.com or (423) 535-5717, option 2. No referral validity window is published. [7][2][3]
- **Telehealth**: Follows the TennCare rule: telehealth hours are requested and authorized per code on the universal tri-MCO form, which carries an “Indicate if Hours are telehealth” checkbox on every ABA code and lists Telehealth among the places of service. No BlueCare-specific ABA telehealth policy was located — its own initiation/continuation and assessment forms collect proposed service locations without a telehealth rule of their own — so the shared program description’s caution about clinical appropriateness, HIPAA-compliant technology and provider competence is the operative standard. [3][6][7]
- **Prior-auth decision time**: BlueCare's July 2026 manual: for a standard request, BlueCare "will provide notice as expeditiously as the member's condition requests and within State-established timeframes that may not exceed 7 calendar days following the receipt of the request for service." It may add "up to 14 additional calendar days" if the member or provider asks, or if BlueCare justifies needing more information. Expedited requests are decided "no later than 72 hours after the receipt of the request for service." That 72 hours can also stretch by up to 14 days on the same grounds. The clock runs from receipt. BlueCare's ABA form says continuation requests "must be submitted at least once every six months" (26-week periods) but sets no lead time before expiry. [1][8][2]
- **Other insurance (who pays first)**: BlueCare, TennCareSelect and CoverKids "are always the payers of last resort." Bill the commercial plan first. The secondary claim must carry "the primary payer's explanation of benefits" and must be "received within 120 days from the date the primary insurer's remittance was produced." BlueCare pays only the gap up to its own allowed amount: if the other carrier paid at or above BlueCare's allowable, "BCT will make no additional reimbursement." Pay-and-chase exception: claims for "TennCare Kids," "Preventive pediatric care," all CoverKids members under 21, and absent-parent insurance "will not be denied for a primary carrier's EOB." BlueCare pays and recovers from the other plan, though the manual notes billing the other carrier first earns "the higher reimbursement rate." The manual does not say whether an ABA claim counts as "TennCare Kids." It also says to seek the primary insurer's prior authorization first only when BlueCare is secondary to Medicare. It is silent on a commercial primary. The TennCare contract lets the MCO deny a claim the primary denied for "failure to obtain prior authorization." Get the commercial PA, and confirm with BlueCare whether its own ABA PA is still needed. TRICARE by statute pays only after other coverage "except in the case of a plan administered under title XIX" (Medicaid), so TRICARE goes before TennCare. CHAMPVA is the reverse: "If you are eligible under Medicaid, CHAMPVA will pay first." [1][8][9][10]
  - Ask the plan: BlueCare Provider Service / UM (Availity) — ask whether an ABA claim for a member under 21 falls under the "TennCare Kids" pay-and-chase line, and whether BlueCare wants its own ABA authorization when a commercial plan is primary.

## Delivery and billing rules

Coverage decides whether BlueCare Tennessee (BCBST) 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.

- **Supervision**: Follows the TennCare rule: direct ABA must be delivered by or supervised by a TN Licensed Behavior Analyst (or a health professional permissible under TN law), unlicensed persons work “under the extended authority and direction of a TN LBA,” and RBTs plus their supervising BCBAs must comply with all current BACB supervision requirements — which sets the operative floor at 5% of monthly service hours with two face-to-face contacts. BlueCare publishes no ratio of its own; its forms capture the provider’s name, credentials and NPI/Tax ID rather than a supervision schedule. [6][2]
- **Daily limits / MUEs**: No per-day ceiling and no annual limit. BlueCare authorizes in 26-week (six-month) certification periods and its initiation/continuation form asks for hours per week by code, a clinical justification for any increase, and — “if concurrent” — the hours approved versus hours used in the last authorization period. That last field is the operative constraint: like every TennCare MCO, BlueCare expects an explanation when utilization of authorized direct-care units falls below 90%. [2][3]
- **Place of service**: Follows the TennCare rule: Clinic, Home, Community, School, Telehealth and Other are all on the universal form’s place-of-service grid, and medically necessary school-based behavioral health services “are not required to be included in a child’s Individualized educational plan (IEP) in order to be reimbursable.” BlueCare’s assessment form asks providers to state where “ABA therapy will be provided between the qualified practitioner and the individual member and/or caregiver at the following proposed location(s),” so the setting is authorized rather than assumed. IEP services and functioning as an educational aide remain non-covered. [6][3][7]
- **Bill as provider**: Follows the TennCare rule — the claim rides on the group or servicing provider with the practitioner level carried as a modifier (HO for analyst-delivered codes, HM for technician-delivered, 97153 split between them). BlueCare’s own forms collect “Provider ID, NPI Number, or Tax ID” plus the provider name and credentials; no separate rendering-versus-supervising NPI convention is published, and rates are contract-negotiated because TennCare publishes no ABA fee schedule. [3][2]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not answered. BlueCare publishes no same-clock-time rule for 97153 with 97155, and the shared program description addresses only two other situations — more than one licensed analyst serving a member “during a specific time interval” and ABA delivered simultaneously with OT, speech, PT or psychotherapy. What BlueCare does say is the converse for scheduling: “the hours per week authorized aren’t inclusive of other services being provided (e.g. occupational therapy, physical therapy),” so a full therapy calendar does not shrink the ABA request. [2][6]
  - Ask the plan: BlueCare behavioral health — BHABA@bcbst.com or (423) 535-5717, option 2 — and the BlueCare Tennessee Provider Administration Manual’s ABA and claim-editing sections.

## What intake should collect for BlueCare Tennessee (BCBST)

- **BlueCare vs. TennCareSelect vs. CoverKids:** Same BCBST machinery, different fax lines — confirm the exact program.
- **Diagnostic report + doctor's order:** Both attach to the universal form for the assessment PA.
- **Severity levels + requested hours by code:** BlueCare's supplemental form asks for severity (1–3) and hours/week per code.
- **Full therapy schedule:** ABA hours are counted separately from OT/PT — document everything.

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

## Verification of benefits (VOB) data

How BlueCare Tennessee (BCBST) ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Behavioral health administrator:** none — in-house (inferred from absence): BlueCare's own 563-page Provider Administration Manual lists "Applied Behavior Analyst Services" as one of many Behavioral Health PA categories BlueCare handles directly, submitted via BlueCare's own forms — no external BH vendor (Carelon/Optum/Magellan) named anywhere in its Behavioral Health sections — BCBST provider services, (423) 535-5717 option 2, or BHABA@bcbst.com (both already cited in tennessee.ts) — this guide found no primary source stating "no carve-out" in so many words, only its absence across a 563-page manual's Behavioral Health sections, so the field is not upgraded to a fully confirmed "none."
- **BH administrator payer ID:** N/A
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required — Universal Request for ABA form (assessment + treatment) | No fixed numeric cap published — "Units Per Week"/"Units per Authorization period" are blank fields on the Universal Request form, justified via the severity/unit guide (levels 1-3 across communication, social, behavior, and adaptive domains) per 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | HO |
| 97152 | Yes | Required — Universal Request for ABA form (assessment + treatment) | No fixed numeric cap published — "Units Per Week"/"Units per Authorization period" are blank fields on the Universal Request form, justified via the severity/unit guide (levels 1-3 across communication, social, behavior, and adaptive domains) per 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | HM |
| 97153 | Yes | Required — Universal Request for ABA form (assessment + treatment) | No fixed numeric cap published — "Units Per Week"/"Units per Authorization period" are blank fields on the Universal Request form, justified via the severity/unit guide (levels 1-3 across communication, social, behavior, and adaptive domains) per 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | HO (BCBA/LBA-delivered — billed "97153HO" per BlueCare's Provider Administration Manual, eff. DOS 9/1/2019+), HM (RBT/technician-delivered) |
| 97154 | Yes | Required — Universal Request for ABA form (assessment + treatment) | No fixed numeric cap published — "Units Per Week"/"Units per Authorization period" are blank fields on the Universal Request form, justified via the severity/unit guide (levels 1-3 across communication, social, behavior, and adaptive domains) per 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | HM |
| 97155 | Yes | Required — Universal Request for ABA form (assessment + treatment) | No fixed numeric cap published — "Units Per Week"/"Units per Authorization period" are blank fields on the Universal Request form, justified via the severity/unit guide (levels 1-3 across communication, social, behavior, and adaptive domains) per 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | HO |
| 97156 | Yes | Required — Universal Request for ABA form (assessment + treatment) | No fixed numeric cap published — "Units Per Week"/"Units per Authorization period" are blank fields on the Universal Request form, justified via the severity/unit guide (levels 1-3 across communication, social, behavior, and adaptive domains) per 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | HO |
| 97157 | Yes | Required — Universal Request for ABA form (assessment + treatment) | No fixed numeric cap published — "Units Per Week"/"Units per Authorization period" are blank fields on the Universal Request form, justified via the severity/unit guide (levels 1-3 across communication, social, behavior, and adaptive domains) per 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | HO |
| 97158 | Yes | Required — Universal Request for ABA form (assessment + treatment) | No fixed numeric cap published — "Units Per Week"/"Units per Authorization period" are blank fields on the Universal Request form, justified via the severity/unit guide (levels 1-3 across communication, social, behavior, and adaptive domains) per 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | HO |
| 0362T | Yes | Required — Universal Request for ABA form (assessment + treatment); listed with a full CPT description in BlueCare's own Provider Administration Manual (this code, unlike the shared tri-MCO documents, which omit it) | 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | — |
| 0373T | Yes | Required — Universal Request for ABA form (assessment + treatment); listed with a full CPT description in BlueCare's own Provider Administration Manual (this code, unlike the shared tri-MCO documents, which omit it) | 26 weeks (6 months) per authorization period | clinic, home, community, school, telehealth | BlueCare's general (not ABA-code-specific) telehealth billing policy (eff. 10/1/2024) requires POS 10 (patient's home) or POS 02 (elsewhere) — POS 03 for school-based, POS 50/72 for RHC/FQHC — with modifiers GT, 93, 95, G0, GQ, FQ, or FR "for informational purposes." Whether this code is on BlueCare's separately-published "Telehealth Approved Code List" (referenced but not included in the manual read this pass) is not directly confirmed. | — |

Code notes:

- **97153:** Continuation requests must report % of authorized units used on this code — under 90% requires a written explanation. Billed "97153HO" when BCBA/QHP-delivered vs. plain 97153 when technician-delivered (eff. DOS 9/1/2019+, per BlueCare's Provider Administration Manual).
- **97155:** Per BlueCare's Provider Administration Manual: may be billed concurrently with technician-delivered codes when the BCBA is directing an RBT, the client is present, and one or more protocols have been modified.
- **97156:** Parent-training volume delivered is tracked separately at continuation, per week/month, on the Universal Request form.

### Contacts

- **Provider services phone:** 1-800-924-7141 — BlueCare Tennessee Provider Service Line, also listed as the Prior Authorization (Medical and Behavioral Health) phone number in the Provider Administration Manual's own "Contact Us" table
- **Phone menu path:** (423) 535-5717, option 2 — reaches BlueCare's in-house behavioral health/UM team (BHABA@bcbst.com) for ABA-specific PA questions
- **Portal:** [BlueCare online provider tool (bluecare.bcbst.com) / Availity](https://bluecare.bcbst.com)
- **Fax:** 1-800-292-5311 (BlueCare/TennCareSelect prior-authorization fax; CoverKids uses a separate fax, 1-800-851-2491)

Questions to ask on a verification call:

- Is 0362T (or 0373T) on BlueCare's current Telehealth Approved Code List, and is there a published unit cap for either code?
- What modifier, if any, does BlueCare want on 0362T/0373T claims — its own code table gives a CPT description but no modifier for these two codes?
- Can eligibility/benefits for this member be checked in real time through a clearinghouse, or only via Availity's standard batch process?

### VOB data sources

- https://content.bcbst.com/api/public/content/prov-bct-pam.pdf (accessed 2026-07-23)
- https://pverify.com/wp-content/uploads/2026/03/pVerifyPayers_All-Payers-List-3-2026.pdf (accessed 2026-07-23)
- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.tn.gov/content/dam/tn/tenncare/documents/HCFATennCareEDIFrontMatter.pdf (accessed 2026-07-23)
- https://www.provider.wellpoint.com/docs/gpp/TN_WLP_CAID_BH_ABARequirements.pdf (accessed 2026-07-23)
- https://www.provider.wellpoint.com/docs/gpp/TN_WLP_CAID_BH_RequestABA.pdf (accessed 2026-07-23)
- https://content.bcbst.com/api/public/content/aba_initiation_continuation_for_therapy.pdf (accessed 2026-07-23)

## Common questions

### Does BlueCare Tennessee cover ABA therapy?

Yes — BlueCare administers the TennCare ABA benefit under the shared tri-MCO program description: EPSDT members under 21, prior authorization on assessment and treatment, TN LBA licensure for direct ABA.

### How do I submit an ABA prior authorization to BlueCare?

Through Availity (or provider.bcbst.com), or by fax to (800) 292-5311 for BlueCare/TennCareSelect — using the universal tri-MCO ABA request form, plus BlueCare's initiation/continuation form for treatment. Standard decisions come within 7 calendar days of receipt (72 hours if expedited).

### Is BlueCare's ABA policy different from TennCare's?

Clinically, no — the rules are the shared TennCare baseline. The differences are mechanical: BlueCare's portal, fax lines, supplemental form, and UM timelines.

## Primary sources

1. [BlueCare Tennessee Provider Administration Manual](https://content.bcbst.com/api/public/content/prov-bct-pam.pdf)
2. [BlueCare — Initiation and Continuation of ABA Therapy form (rev. 2/26)](https://content.bcbst.com/api/public/content/aba_initiation_continuation_for_therapy.pdf)
3. [Universal Request for ABA form (all 3 MCOs, Jan 2026)](https://www.provider.wellpoint.com/docs/gpp/TN_WLP_CAID_BH_RequestABA.pdf)
4. [Tri-MCO ABA Overview of Updates (Sept 2024)](https://www.provider.wellpoint.com/docs/gpp/TN_WLP_CAID_BH_ABAOverviewofUpdates.pdf)
5. [TennCare Kids (EPSDT) — birth through age 20](https://www.tn.gov/tenncare/tenncare-kids.html)
6. [ABA Provider Requirements & Program Description — TennCare MCOs (rev. 06/2024)](https://www.provider.wellpoint.com/docs/gpp/TN_WLP_CAID_BH_ABARequirements.pdf)
7. [BCBST — ABA Therapy Services Assessment Request Form](https://content.bcbst.com/api/public/content/aba_therapy_assessment_request_form.pdf)
8. [TennCare Statewide MCO Contract (Amendment 25, July 1, 2026) — A.2.19.3.5](https://www.tn.gov/content/dam/tn/tenncare/documents/MCOStatewideContract.pdf)
9. [10 U.S.C. 1079(i)(1) — TRICARE pays after other coverage, Medicaid excepted](https://www.govinfo.gov/content/pkg/USCODE-2023-title10/html/USCODE-2023-title10-subtitleA-partII-chap55-sec1079.htm)
10. [CHAMPVA Guidebook (updated Jan. 1, 2025) — Other Health Insurance](https://www.va.gov/COMMUNITYCARE/docs/pubfiles/programguides/CHAMPVA-Guide.pdf)

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.