---
title: Health New England BeHealthy Partnership ABA coverage (MassHealth ACPP).
url: "https://carelu.com/payers/health-new-england-massachusetts"
markdown_url: "https://carelu.com/payers/health-new-england-massachusetts.md"
state: MA (Massachusetts)
payer: "Health New England — BeHealthy Partnership"
kind: Medicaid managed care plan (MCO)
parent_program: MassHealth
description: "How Health New England's BeHealthy Partnership (with Baystate Healthcare Alliance) handles MassHealth ABA — behavioral health administered by MBHP, the standard PA form, 6-month authorizations, and the Springfield/Baystate catchment."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Health New England BeHealthy Partnership ABA coverage (MassHealth ACPP).

_Payer Guide · HNE BeHealthy · Last updated September 2026 · 6 primary sources_

> Western-MA ACPP (BeHealthy Partnership); ABA auth is the MBHP flow, state-baseline rules.

Health New England's BeHealthy Partnership — its Accountable Care Partnership Plan with Baystate Healthcare Alliance — is the western-Massachusetts entry in the MassHealth landscape, anchored to the Springfield/Baystate systems. For ABA there is one thing to know: HNE doesn't run its own behavioral-health UM. The benefit is administered by MBHP (Carelon), meaning a BeHealthy member's ABA authorization is the MBHP flow — the state-baseline criteria, the Massachusetts Standard ABA PA Form, ProviderConnect, 6-month periods.

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

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — via the MBHP process (Massachusetts Standard ABA PA Form) [6][1]
- **Prior auth for treatment**: Required — via MBHP; 6-month authorization periods [6][1]
- **Autism diagnosis required?**: Yes — ASD via comprehensive DSM-aligned assessment; from 1/1/2026 also sole-diagnosis Down syndrome (state baseline) [6][5]

## At a glance

- **Plan type:** MassHealth ACPP (with Baystate Healthcare Alliance) — western MA
- **BH administrator:** MBHP (Carelon)
- **Clinical rules:** State baseline via MBHP — no HNE-specific ABA policy
- **Prior auth:** Required — MA Standard ABA PA Form; 6-month periods
- **Submission:** providers.masspartnership.com (the MBHP channel)
- **Supervision watch:** One of the six audited plans; first-wave recoupment letters

## The MBHP flow, with an HNE card

BeHealthy Partnership members carry an HNE card, but ABA requests go to MBHP: the standard PA form (initial evaluation, initial services, continued services), 6-month authorization periods, submissions through providers.masspartnership.com. No HNE-specific ABA criteria, forms, or hour caps exist — the state baseline governs, including the Down syndrome pathway from January 1, 2026. For intake in the Springfield catchment, the practical takeaway is routing: build the MBHP workflow once and BeHealthy families slot into it. [1]

## Audit exposure

HNE is named among the six ABA-administering plans in MassHealth's CY2024 supervision-ratio audit and received first-wave recoupment letters — so BeHealthy claims sit under the same 1:10 97155-to-97153 enforcement as the rest of the MBHP/Carelon universe. Schedule supervision hours accordingly and reconcile the ratio before continuation requests. [3]

## Intake gates

The questions that decide whether a family can start with Health New England — BeHealthy Partnership, and what they have to bring.

- **Age limit**: EPSDT sets the bound, and nothing else does. ABA is covered for MassHealth Standard and CommonHealth members under 21, and for Family Assistance members under 19 — with no lower age bound and no dollar, visit or unit-of-service cap underneath it. For the youngest referrals the binding rule is non-duplication rather than age: ABA cannot duplicate services the child already receives through Early Intervention. From 1/1/2026 the second diagnostic pathway (sole-diagnosis Down syndrome) rides the same age structure. [5]
- **Who may diagnose**: The standard form names them, and the list is broader than "send them to a developmental pediatrician." For autism it requires "A comprehensive assessment completed by a licensed physician (i.e. PCP, etc.), advanced practice registered nurse, physician's assistant, or psychologist experienced in the diagnosis and treatment of ASD with developmental or child/adolescent experience which aligns with DSM criteria across ASD core deficits." For the 1/1/2026 pathway it requires instead "A diagnosis of Down Syndrome (Trisomy 21) confirmed by genetic testing." Note the two signatures are different people: the diagnostician writes the assessment, while the form itself "should" be completed by the BCBA rendering and/or supervising the services — an analyst the performance specification requires to be a LABA licensed under 262 CMR 10.00. BeHealthy Partnership members route to MBHP, so the Massachusetts standard form is the operative paperwork; no HNE-specific diagnostic criteria exist. [6][4]
  - Ask the plan: Confirm the member's plan still routes to MBHP at intake — the MassHealth BH-administrator map has changed twice since 2025.
- **Diagnostic tools required**: No instrument is mandated. The standard form requires a comprehensive assessment "which aligns with DSM criteria across ASD core deficits" without naming ADOS-2, ADI-R, CARS-2 or any other tool, and the performance specification names no diagnostic battery either; the Down syndrome pathway replaces the instrument question entirely with genetic testing. Massachusetts puts its measurement requirement downstream of intake instead — in progress documentation and medical-necessity review, not in the diagnostic gate. [6][4]
  - Ask the plan: Confirm the member's plan still routes to MBHP at intake — the MassHealth BH-administrator map has changed twice since 2025.
- **Referral required?**: No referral and no physician order is a condition of authorization. The Massachusetts Standard ABA PA Form has no referral field and is completed by the rendering or supervising BCBA/LABA, and the performance specification's referral language is about timeliness rather than permission: "Fourteen calendar days from referral is the Medicaid standard of timely provision for services established in accordance with 42 CFR 441.56(e)," with a waitlist duty (and an obligation to hand caregivers other regional providers' contact information) where the provider cannot start inside it. What the state does require is PCP evidence in the chart rather than at the door: the complete medical record must hold "Referral and assessment documentation" and "Documentation confirming physical examinations by a PCP," and the continued-services pages ask for a dated primary-care care-coordination entry. [4][6]
  - Ask the plan: Confirm the member's plan still routes to MBHP at intake — the MassHealth BH-administrator map has changed twice since 2025.
- **Telehealth**: Permitted at the family's request, with no code list and no POS rule. The ABA provider "may deliver services and consultation via a Health Insurance Portability and Accessibility Act (HIPAA)-compliant telehealth platform at the parent/caregiver's request and if the service can be effectively delivered via telehealth as part of the intervention when appropriate," with the rationale documented and the documentation reflecting "clinical considerations for appropriateness across any service components being delivered via telehealth." Two guardrails ride along: telehealth "must not replace in-person availability," and the member or family "may rescind consent for telehealth at any time without risk of interruption of services." No per-code restriction, modifier or place-of-service code is published. [4]
  - Ask the plan: Confirm the member's plan still routes to MBHP at intake — the MassHealth BH-administrator map has changed twice since 2025.
- **Prior-auth decision time**: MBHP decides ABA for BeHealthy members, on the federal managed-care clock. HNE's manual says HNE "has partnered with Massachusetts Behavioral Health Partnership (MBHP) to manage behavioral health (BH) services for HNE Be Healthy members." ABA authorization therefore runs through MBHP, and 42 CFR 438.210(d) binds HNE and its vendor. For rating periods that start on or after January 1, 2026, a standard decision is due "as expeditiously as the enrollee's condition requires" and within state-set timeframes that "may not exceed 7 calendar days after receiving the request for service" (it was 14 before 2026). That can be extended "up to 14 additional calendar days" if the family or provider asks, or if the plan justifies needing more information. An expedited decision is due "no later than 72 hours after receipt of the request for service." Expedited applies when the provider indicates that the standard clock "could seriously jeopardize the enrollee's life or health or ability to attain, maintain, or regain maximum function." No reauthorization lead time is published on the standard form or the MBHP performance specification. Continued services are requested in up to 6-month windows. MBHP's own provider manual returned a "System Outage" page when fetched, so an MBHP-specific shorter clock cannot be ruled out. [7][8][6][4]
  - Ask the plan: MBHP provider manual for HNE BeHealthy (masspartnership.com/HNE) or MBHP provider relations: MBHP's ABA decision clock and reauthorization lead time.
- **Other insurance (who pays first)**: HNE pays after other insurance, and its authorization rules still apply. "HNE guidelines with regard to prior approvals must be followed even when another insurer is primary." For a secondary claim, "the provider must bill the primary insurer and should not submit a claim to HNE until after the claim has been processed by the primary insurer." The claim then goes in "with an explanation of payment or denial within 90 days." For a child on two parents' plans, "The plan of the parent whose birthday falls earlier in the year is primary." MassHealth's rule adds that the provider must follow the primary plan's authorization and network rules. A primary denial for missing PA or for being out of network forfeits the secondary payment (130 CMR 450.316). HNE's COB chapter is the general manual (revised 11/1/2023). BeHealthy behavioral-health claims are managed by MBHP. TRICARE pays before MassHealth: "By law, TRICARE pays after all other health insurance, except for: Medicaid." [7][9][10]
  - Ask the plan: MBHP (for HNE BeHealthy BH claims): its secondary-claim filing window and whether it matches HNE's 90 days.

## Delivery and billing rules

Coverage decides whether Health New England — BeHealthy Partnership 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**: BeHealthy Partnership members route their ABA to MBHP, so the Carelon/MBHP performance specification is the operative rule. LABA supervision must be delivered to Behavior Technician-level staff “during direct service with the Member, as clinically indicated but no less than 10 percent of direct service hours and should not exceed 25 percent of direct hours without documented clinical rationale.” For members engaged in 10 hours or less of direct treatment per month, the LABA must deliver a minimum of one hour of direct supervision per month. The Behavior Technician works under the direct supervision of a LABA licensed per 262 CMR 10.00 — a BCBA certificate alone does not qualify — and the provider agency must ensure LABAs supervise all BTs and that every staff member has had a background record check. [4]
  - Ask the plan: Confirm the member’s plan still routes to MBHP at intake — the MassHealth BH-administrator map has changed twice since 2025.
- **Session-note signature**: Both clinicians document, and the spec says what the note must contain rather than who countersigns it. “The LABA and BT document each contact in a progress report or notes in the ABA provider’s file for the Member,” and session notes must include how treatment time was utilized, the treatment interventions utilized, and the member’s response to treatment. The complete record must also hold referral and assessment documentation, treatment plans and progress reports, “evidence of supervision and training, including policies, procedures, and implementation,” the IEP and IFSP where applicable, and documentation confirming PCP physical examinations. No co-signature requirement and no signing deadline are stated. [4]
  - Ask the plan: Confirm MBHP routing for the specific member.
- **Place of service**: Home and community, with school carved out. ABA “is delivered by a contracted and credentialed provider in a variety of settings within a Member’s home and community,” and “services provided in a school setting are distinct and separate from those covered by the health plan and are typically covered by the educational system’s special education resources as part of the Individualized Education Program (IEP) pursuant to Public Law 94-142.” Providers “must not direct, limit, or discourage access to other medically necessary or school-based services.” Transition planning contemplates moving a member “from a center based setting to home/community settings,” so centers are in scope. Group homes are not addressed. [4]
  - Ask the plan: Confirm MBHP routing for the specific member.
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not resolved in the published Massachusetts documents. The performance specification does carry one concurrency prohibition, but it is about siblings, not codes: in group caregiver training, “providers may not bill concurrently for services delivered to multiple children from the same family. When a parent/caregiver has more than one child receiving services, only one child’s session may be billed at a time.” The spec requires LABA supervision to be delivered during the BT’s direct service with the member, and MassHealth’s CY2024 audit measured 97155 hours against 97153 hours — but neither document states in terms that both codes may be billed for the same clock time. [4]
  - Ask the plan: Carelon/MBHP provider relations via ProviderConnect.

## What intake should collect for Health New England — BeHealthy Partnership

- **BeHealthy → MBHP routing:** The HNE card routes ABA to MBHP — use the ProviderConnect workflow, not an HNE portal.
- **Diagnostic evaluation:** ASD assessment (or the 1/1/2026 Down syndrome pathway) for the standard form.
- **LABA of record:** The standard form is completed by the rendering or supervising LABA.
- **Supervision capacity:** Audited plan — hold ≥1:10 97155:97153 in the schedule.

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

## Verification of benefits (VOB) data

How Health New England — BeHealthy Partnership ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 00601
- **Payer ID (Availity):** 04286 — Sourced from the stale (2012) Availity payer list — downgraded to inferred pending reconfirmation against a current Availity export (same treatment already applied in vob/georgia.ts for the identical staleness finding).
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** MBHP (Carelon) — BeHealthy Partnership members' ABA authorization is the MBHP flow
- **BH administrator payer ID:** 43324 (claim.md) / BHOVO (Stedi) / 00831 (pVerify) / ISA Receiver ID BEACON963116116 (Carelon national companion guide) — genuinely multiple identifiers across clearinghouses for the same Carelon/Beacon entity, not resolved to one canonical number.
- **ABA rides on:** behavioral health benefit
- **Two-hop verification required:** Yes

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required — PA is required for all ABA services/hours/units, assessment and treatment alike | — | home/community (default), center-based/clinic (documented clinical justification required per the Carelon/MBHP performance spec), school (carved to IEP/DESE — not billed to the health plan) | Yes, as a modality — allowed at parent/caregiver request when clinically appropriate per the Carelon/MBHP performance spec; must not replace in-person availability. No telehealth modifier (GT/95) or POS code is specified in the spec. | — |
| 97152 | Yes (assumed covered under the comprehensive EPSDT benefit; not separately priced in the current 101 CMR 358.03 fee schedule — see Layer 4 rates) | Required — PA is required for all ABA services/hours/units, assessment and treatment alike | — | home/community (default), center-based/clinic (documented clinical justification required per the Carelon/MBHP performance spec), school (carved to IEP/DESE — not billed to the health plan) | Yes, as a modality — allowed at parent/caregiver request when clinically appropriate per the Carelon/MBHP performance spec; must not replace in-person availability. No telehealth modifier (GT/95) or POS code is specified in the spec. | — |
| 97153 | Yes | Required — PA is required for all ABA services/hours/units, assessment and treatment alike | — | home/community (default), center-based/clinic (documented clinical justification required per the Carelon/MBHP performance spec), school (carved to IEP/DESE — not billed to the health plan) | Yes, as a modality — allowed at parent/caregiver request when clinically appropriate per the Carelon/MBHP performance spec; must not replace in-person availability. No telehealth modifier (GT/95) or POS code is specified in the spec. | — |
| 97154 | Yes | Required — PA is required for all ABA services/hours/units, assessment and treatment alike | 18 units/day (≤4.5 hrs), group size 2–8 members per day | home/community (default), center-based/clinic (documented clinical justification required per the Carelon/MBHP performance spec), school (carved to IEP/DESE — not billed to the health plan) | Yes, as a modality — allowed at parent/caregiver request when clinically appropriate per the Carelon/MBHP performance spec; must not replace in-person availability. No telehealth modifier (GT/95) or POS code is specified in the spec. | — |
| 97155 | Yes | Required — PA is required for all ABA services/hours/units, assessment and treatment alike | — | home/community (default), center-based/clinic (documented clinical justification required per the Carelon/MBHP performance spec), school (carved to IEP/DESE — not billed to the health plan) | Yes, as a modality — allowed at parent/caregiver request when clinically appropriate per the Carelon/MBHP performance spec; must not replace in-person availability. No telehealth modifier (GT/95) or POS code is specified in the spec. | — |
| 97156 | Yes | Required — PA is required for all ABA services/hours/units, assessment and treatment alike | — | home/community (default), center-based/clinic (documented clinical justification required per the Carelon/MBHP performance spec), school (carved to IEP/DESE — not billed to the health plan) | Yes, as a modality — allowed at parent/caregiver request when clinically appropriate per the Carelon/MBHP performance spec; must not replace in-person availability. No telehealth modifier (GT/95) or POS code is specified in the spec. | — |
| 97157 | Yes | Required — PA is required for all ABA services/hours/units, assessment and treatment alike | 18 units/day (≤4.5 hrs), group size 2–8 members per day | home/community (default), center-based/clinic (documented clinical justification required per the Carelon/MBHP performance spec), school (carved to IEP/DESE — not billed to the health plan) | Yes, as a modality — allowed at parent/caregiver request when clinically appropriate per the Carelon/MBHP performance spec; must not replace in-person availability. No telehealth modifier (GT/95) or POS code is specified in the spec. | — |
| 97158 | Yes (assumed covered under the comprehensive EPSDT benefit; not separately priced in the current 101 CMR 358.03 fee schedule — see Layer 4 rates) | Required — PA is required for all ABA services/hours/units, assessment and treatment alike | — | home/community (default), center-based/clinic (documented clinical justification required per the Carelon/MBHP performance spec), school (carved to IEP/DESE — not billed to the health plan) | Yes, as a modality — allowed at parent/caregiver request when clinically appropriate per the Carelon/MBHP performance spec; must not replace in-person availability. No telehealth modifier (GT/95) or POS code is specified in the spec. | — |
| 0362T | Yes (assumed covered under the comprehensive EPSDT benefit; not separately priced in the current 101 CMR 358.03 fee schedule — see Layer 4 rates) | Required — PA is required for all ABA services/hours/units, assessment and treatment alike | — | home/community (default), center-based/clinic (documented clinical justification required per the Carelon/MBHP performance spec), school (carved to IEP/DESE — not billed to the health plan) | Yes, as a modality — allowed at parent/caregiver request when clinically appropriate per the Carelon/MBHP performance spec; must not replace in-person availability. No telehealth modifier (GT/95) or POS code is specified in the spec. | — |
| 0373T | Yes (assumed covered under the comprehensive EPSDT benefit; not separately priced in the current 101 CMR 358.03 fee schedule — see Layer 4 rates) | Required — PA is required for all ABA services/hours/units, assessment and treatment alike | — | home/community (default), center-based/clinic (documented clinical justification required per the Carelon/MBHP performance spec), school (carved to IEP/DESE — not billed to the health plan) | Yes, as a modality — allowed at parent/caregiver request when clinically appropriate per the Carelon/MBHP performance spec; must not replace in-person availability. No telehealth modifier (GT/95) or POS code is specified in the spec. | — |

Code notes:

- **97151, 97153, 97155, 97156:** No HNE-specific ABA billing document was found — this entry is inferred from the statewide Carelon/MBHP pattern (BeHealthy Partnership routes ABA authorization to MBHP), not independently confirmed against an HNE-published coding document.
- **97152, 97158, 0362T, 0373T:** Not separately priced in the current fee schedule — see Layer 4 for the individual-consideration note. No HNE-specific ABA billing document was found — this entry is inferred from the statewide Carelon/MBHP pattern (BeHealthy Partnership routes ABA authorization to MBHP), not independently confirmed against an HNE-published coding document.
- **97154, 97157:** Group-session cap and size come from the Carelon/MBHP performance spec, not a fee-schedule/coding source. No HNE-specific ABA billing document was found — this entry is inferred from the statewide Carelon/MBHP pattern (BeHealthy Partnership routes ABA authorization to MBHP), not independently confirmed against an HNE-published coding document.

### Contacts

- **Provider services phone:** 1-800-397-1630
- **Phone menu path:** For member eligibility, authorization confirmation, and claims status specifically, call 1-888-421-8861 (Beacon Member Services).
- **Hours:** 8:00 a.m.-8:00 p.m. ET, Monday-Friday (National Provider Service Line - HNE's ABA authorization routes to MBHP/Carelon per this file's already-verified facts)
- **Portal:** [Beacon/Carelon eServices](https://www.beaconhealthoptions.com)

Questions to ask on a verification call:

- Can you confirm HNE's current Availity payer ID (the one on file is sourced from a 2012 list)?
- Does HNE / BeHealthy Partnership support real-time 270/271 eligibility checks?
- Are there HNE-specific per-code unit caps, POS restrictions, or billing modifiers that differ from the statewide MBHP baseline?

### VOB data sources

- https://pverify.com/payer-list/ (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.claim.md/payer/43324 (accessed 2026-07-23)
- https://www.stedi.com/healthcare/network/carelon-behavioral-health (accessed 2026-07-23)
- https://www.mass.gov/doc/masshealth-standard-companion-guide-health-care-eligibilitybenefit-inquiry-and-information-response-270271-0/download (accessed 2026-07-23; source document older than 18 months)
- https://www.mass.gov/doc/rates-for-applied-behavior-analysis-effective-october-1-2024-0/download (accessed 2026-07-23; source document older than 18 months)
- https://providers.masspartnership.com/pdf/PerfSpec-ABA.pdf (accessed 2026-07-23)
- https://www.carelonbehavioralhealth.com/content/dam/digital/carelon/cbh-assets/documents/ma/behavioral-health-policy-and-procedure-manual-for-providers-fallon.pdf (accessed 2026-07-23; source document older than 18 months)

## Common questions

### Does HNE's BeHealthy Partnership cover ABA?

Yes — the state-baseline MassHealth EPSDT benefit, with behavioral health administered by MBHP (Carelon): standard PA form, 6-month authorizations, no published caps.

### Where do BeHealthy ABA authorizations go?

To MBHP, via providers.masspartnership.com — not to Health New England. It's the same flow as PCC Plan and Primary Care ACO members.

## Primary sources

1. [MassHealth Managed Care Options — plan/BH-vendor map (April 2023)](https://abh.memberclicks.net/assets/docs/KeepingCoverage/2023%20MassHealth%20Accountable%20and%20Managed%20Care%20Options%20031723.pdf)
2. [MBHP provider portal — ProviderConnect](https://providers.masspartnership.com/provider/GettingStarted.html)
3. [MassHealth ABA supervision audit & recoupment (Acuity News)](https://acuity.news/regulation/masshealth-aba-supervision-audit-recoupment-litigation-2026/)
4. [Carelon/MBHP Performance Specifications — Applied Behavior Analysis (upd. Feb 15, 2026)](https://providers.masspartnership.com/pdf/PerfSpec-ABA.pdf)
5. [AIRC — MassHealth ABA Coverage factsheet](https://massairc.org/factsheets/masshealth-aba-coverage/)
6. [MA Standard ABA PA Form (MassHealth version, upd. 3/12/2026)](https://www.wellsense.org/hubfs/Forms/Provider_Forms/Applied_Behavioral_Analysis_Prior_Authorization_Form_MassHealth.pdf)
7. [Health New England Provider Manual (full; COB chapter rev. 11/1/2023)](https://healthnewengland.org/provider-manual)
8. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/section-438.210)
9. [130 CMR 450.316 — MassHealth third-party liability: requirements (Cornell LII mirror)](https://www.law.cornell.edu/regulations/massachusetts/130-CMR-450-316)
10. [TRICARE — Using Other Health Insurance](https://tricare.mil/Plans/OHI)

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.