---
title: Independent Health ABA coverage (NY Medicaid Managed Care).
url: "https://carelu.com/payers/independent-health-new-york"
markdown_url: "https://carelu.com/payers/independent-health-new-york.md"
state: NY (New York)
payer: Independent Health (NY Medicaid)
kind: Medicaid managed care plan (MCO)
parent_program: New York Medicaid
description: "How Independent Health (MediSource) handles NY Medicaid ABA — the Erie County-only footprint, Carelon's behavioral-health delegation and where ABA appears to sit outside it, and the prior-auth and billing specifics that remain unpublished."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# Independent Health ABA coverage (NY Medicaid Managed Care).

_Payer Guide · Independent Health (NY) · Last updated September 2026 · 7 primary sources_

> Erie County/Buffalo only (not Monroe); Carelon runs general BH, but ABA looks to be administered directly by Independent Health — confirm which before routing a case.

Independent Health Association runs NY Medicaid Managed Care under the brand "MediSource" (HARP: MediSource Connect), covering 60,812 members per the state's July 2026 enrollment report — all of them in Erie County, the Buffalo market; the state's own enrollment tables do not list Independent Health under Monroe County, so treat this as a Buffalo/Erie plan rather than a Buffalo-and-Rochester one. Independent Health delegates behavioral health benefit management for its state products to Carelon Behavioral Health — but the evidence points to ABA sitting outside that delegation: the current MediSource member handbook places its ABA section apart from the "Behavioral Health Care" section that carries Carelon's crisis-line branding throughout, describing ABA in "Independent Health covers..." language instead. That distinction isn't stated explicitly in a single provider-facing sentence we could find, so this guide treats it as strongly indicated rather than certain, and flags it as the first thing to confirm on any Independent Health case.

This plan administers the **New York Medicaid** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [New York Medicaid (NYS DOH / eMedNY) guide](https://carelu.com/payers/new-york-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment:** Not published / unverified. Verify via: Independent Health’s provider prior-authorization procedure-code grid for MediSource, which sits behind the HealthTrio Connect provider-portal login — the handbook’s member-facing PA list is a simplified summary, not that grid. Provider Services (716-250-7183 / 1-833-891-9372) in the meantime. [2]
- **Prior auth for treatment:** Not published / unverified. Verify via: The same HealthTrio-gated MediSource prior-authorization procedure-code grid — and settle the routing question with Provider Services first (716-250-7183 / 1-833-891-9372): whether Independent Health or Carelon Behavioral Health actually adjudicates ABA authorizations and claims. [2][1]
- **Autism diagnosis required?**: Yes — state baseline: under 21, ASD and/or Rett syndrome, assessed/treated by a Licensed Behavior Analyst or a Certified Behavior Analyst Assistant under LBA supervision, per the MediSource member handbook [2][7]

## At a glance

- **Plan type:** Mainstream MMC — "MediSource"; HARP: "MediSource Connect" (Independent Health Association, Inc.)
- **Footprint:** Erie County (Buffalo) — the state's enrollment tables do not list Independent Health under Monroe County
- **BH/ABA UM:** Carelon Behavioral Health manages general BH for MediSource; ABA appears to sit outside that delegation and be administered by Independent Health directly (strongly indicated, not confirmed in an explicit statement)
- **Prior auth:** Not published for ABA codes specifically — the member handbook's general PA list doesn't name ABA; confirm with Provider Services
- **Providers:** Licensed Behavior Analyst (LBA), or Certified Behavior Analyst Assistant (CBAA) under LBA supervision, per the MediSource handbook
- **Portal:** HealthTrio Connect (general); Carelon's provider.beaconhealthoptions.com for BH-delegated services

## The Carelon delegation — and why ABA looks like the exception

Independent Health states directly, on its current provider policies page, that "Carelon now oversees all behavioral health benefit management services for our MediSource, MediSource Connect, Child Health Plus and Essential Plans" — covering appeals, care management, claims, eligibility, prior authorization, network operations, and utilization review for behavioral health generally. But the 2026 MediSource Member Handbook places its "Applied Behavior Analysis (ABA) Services" description in a separate part of the document — grouped with Children's HCBS and Article 29-I VFCA services rather than the "Behavioral Health Care" (mental health/substance use) section — and describes it in "Independent Health covers..." and "Independent Health will work with you and your provider" language, with no Carelon reference anywhere in that section, while every page of the Behavioral Health Care section footers Carelon's crisis line. That placement is consistent with New York's statewide pattern of no BH-vendor carve-out for the mainstream MMC ABA benefit — but because no single sentence confirms it plainly, verify with Provider Services which entity (Independent Health or Carelon) actually adjudicates ABA authorizations and claims before routing a case to either one. [1][2]

## Eligibility and providers, per the member handbook

The MediSource handbook states ABA is covered for children/youth under 21 with autism spectrum disorder and/or Rett syndrome, with assessment and treatment delivered by a physician, Licensed Behavior Analyst (LBA), or Certified Behavior Analyst Assistant (CBAA) working under LBA supervision — matching the state's licensure framework. Covered service types named include individual treatment in the home or another setting, group adaptive behavior treatment, and family/caregiver training and support. No Independent Health-specific documentation list (beyond the state's own referral requirements), assessment instruments, or reauthorization cadence is published for MediSource — those specifics, if they exist, sit behind the HealthTrio provider-portal login. [2]

## Prior authorization, telehealth, and billing basics

No Independent Health document we could access confirms whether the ABA assessment or treatment codes require prior authorization for MediSource — the handbook's general member-facing PA-required list (out-of-plan services, subacute/SNF admissions, home care, personal care, PERS, mental health, DME, certain surgeries) does not name ABA specifically, but that list is a simplified member summary, not the provider procedure-code grid, so its silence isn't proof no PA is required. No ABA-specific telehealth policy was found either. On billing: Carelon's claims rules for Independent Health's other behavioral-health services set timely filing at 90 days from date of service for MediSource (120 days for Essential Plan/Child Health Plus) — whether that same window applies to ABA claims, or whether ABA bills to Independent Health directly on a different timeline, is unconfirmed. Confirm PA requirements, telehealth eligibility, and the correct claims-filing window with Provider Services before booking or billing. [5][2]

## Intake gates

The questions that decide whether a family can start with Independent Health (NY Medicaid), and what they have to bring.

- **Age limit**: Stated in the plan’s own member handbook and matching the state: the MediSource handbook covers ABA for children and youth under 21 with autism spectrum disorder and/or Rett syndrome. No minimum age; no adult pathway. [2][7]
- **Diagnosis recency**: Follows the New York Medicaid rule — the two-year referral is the clock, and no maximum age is set on the diagnostic evaluation. “No Independent Health-specific documentation list (beyond the state’s own referral requirements), assessment instruments, or reauthorization cadence is published for MediSource”; those specifics, if they exist, sit behind the HealthTrio provider-portal login. [7][2]
  - Ask the plan: Independent Health Provider Services or the HealthTrio Connect portal — confirm whether MediSource adds a recency rule.
- **Who may diagnose**: Follows the New York Medicaid rule for the referral, with the handbook restating the delivery side: assessment and treatment are delivered “by a physician, Licensed Behavior Analyst (LBA), or Certified Behavior Analyst Assistant (CBAA) working under LBA supervision.” LBAs and CBAAs may not diagnose or self-refer, so the diagnosing clinician must come from the state’s practitioner list. [2][7]
- **Diagnostic tools required**: Follows the New York Medicaid rule: no instrument is mandated. What the state requires with the referral is the “DSM-5 Diagnostic Checklist for ASD diagnoses” plus the severity level when the referral comes from an ASD-diagnosing provider; the treatment plan need only record the assessment methodology used and, “as appropriate, identify standardized assessment used (e.g., adaptive behavior scales, symptom inventories, aggression ratings) and results.” No Independent Health-specific instrument requirement is published for MediSource. [7][2]
  - Ask the plan: Independent Health Provider Services or the HealthTrio Connect portal.
- **Referral required?**: Follows the New York Medicaid rule: the member “must be referred for ABA services by a NYS-licensed and NYS Medicaid-enrolled physician, psychologist, psychiatric nurse practitioner, pediatric nurse practitioner, or physician assistant,” the referral is “valid for no more than two years,” and it must carry age, the ASD/Rett diagnosis, date of initial diagnosis, co-morbid diagnoses, symptom severity level, a statement the patient needs ABA, and the DSM-5 Diagnostic Checklist. Whether MediSource layers prior authorization on the ABA codes is unresolved: the handbook’s general member-facing PA-required list (out-of-plan services, subacute/SNF admissions, home care, personal care, PERS, mental health, DME, certain surgeries) does not name ABA, but that list is a simplified member summary rather than the provider procedure-code grid, so its silence is not proof. The first thing to settle on any case is which entity adjudicates: Carelon Behavioral Health manages general BH for Independent Health’s state products, while ABA appears from the handbook’s structure to be administered by Independent Health directly — strongly indicated, not stated in one explicit sentence. [7][2][1]
  - Ask the plan: Independent Health Member/Provider Services (716-250-7183 / 1-833-891-9372) — confirm in writing whether ABA requires PA and whether Independent Health or Carelon adjudicates it.
- **Prior-auth decision time**: MediSource behavioral health prior authorization and utilization review are run by Carelon Behavioral Health. Independent Health’s 2026 MediSource handbook sets the clock: standard review “within 3 work days of when we have all the information we need, but you will hear from us no later than 14 days after we receive your request”; fast track “within 72 hours”; a continued-service (concurrent) request within one work day of complete information, no later than 14 days (72 hours if fast-track). Federal rules cap the standard decision at 7 calendar days for plan rating periods starting on or after January 1, 2026, which is tighter than the handbook’s 14. No ABA reauth submission lead time is published; the provider manual is behind the HealthTrio login. [2][1][8]
- **Telehealth** _(ask the plan)_: Not published. No ABA-specific telehealth policy was found in any Independent Health document we could access, and the state manual answers telehealth only for supervision. [2][7]
  - Ask the plan: Independent Health Provider Services — confirm telehealth eligibility, code list and place of service before scheduling remote sessions.

## Delivery and billing rules

Coverage decides whether Independent Health (NY Medicaid) 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**: The MediSource handbook restates New York’s structure — ABA delivered by a physician, an LBA, or a CBAA working under LBA supervision — and the numeric floor comes from the state, applying to managed care alike: 5% of each unlicensed individual’s monthly service hours, at least two face-to-face real-time contacts per month with one observation, and no more than six CBAAs/unlicensed individuals per LBA. [2][7]
- **Session-note signature**: Follows the New York Medicaid rule: the LBA supervisor must “review and sign treatment notes and reports prepared by the CBAA supervisee,” and documentation of supervision itself “should be recorded in the patient file.” Clinical documentation must carry the treatment plan with assessment and goals, the goal data, total hours of service per week by who delivered them, and the location(s) of services. Records are kept “for a minimum of six years and, for minors, until the patient turns 22 years of age.” No Independent Health-specific documentation or signature rule was located for MediSource. [7][2]
- **Place of service**: The MediSource handbook names the covered service types — individual treatment in the home or another setting, group adaptive behavior treatment, and family/caregiver training and support — without publishing a setting restriction of its own. The state rule supplies the limit: any legally authorized setting, but NYS Medicaid does not reimburse ABA in a school setting. [2][7]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not published. Independent Health’s retrievable ABA content is the member handbook’s benefit description; no claim-edit rule for 97153 with 97155 was located, and the state manual is silent. [2][7]
  - Ask the plan: Independent Health Provider Services — and confirm first whether Independent Health or Carelon adjudicates ABA claims for the member.
- **Daily limits / MUEs** _(ask the plan)_: Not published — no authorization periods, unit ceilings or hour-cap logic appear in the MediSource materials we could access, and the state sets no per-day ceiling either. On claims, Carelon’s rules for Independent Health’s other behavioral-health services set timely filing at 90 days from date of service for MediSource (120 days for Essential Plan and Child Health Plus), but whether that window applies to ABA — or whether ABA bills to Independent Health directly on a different timeline — is unconfirmed. [2][1]
  - Ask the plan: Independent Health Provider Services — confirm authorization periods, unit limits and the correct claims-filing window for ABA specifically.
- **Bill as provider** _(ask the plan)_: Not published, and the routing question comes first: confirm whether Independent Health or Carelon Behavioral Health actually adjudicates ABA authorizations and claims for the member before submitting anything, since the public materials do not settle it explicitly. At the fee-for-service layer New York is explicit: LBAs bill “using the LBA’s National Provider Identification (NPI) number for the ‘Billing’ provider and/or ‘Supervising’ provider,” with “the NPI number of the CBAA that provided the ABA service… reported as the ‘Rendering’ provider on each claim”; for unlicensed aides and LBA limited-permit holders the supervising LBA’s NPI fills all three roles. CBAAs cannot bill directly and enroll as OPRA providers. [1][2][7]
  - Ask the plan: Independent Health Provider Services — confirm the adjudicating entity, the rendering/supervising NPI convention and the claims-filing window.

## What intake should collect for Independent Health (NY Medicaid)

- **Complete state referral packet:** Under-21 ASD/Rett dx, referral with severity and DSM-5 checklist — the clinical baseline MediSource sits on top of.
- **Which entity to route to:** Confirm whether Independent Health or Carelon actually handles ABA authorization/claims for this member before submitting anything — the public materials don't settle it explicitly.
- **LBA/CBAA credentials:** The handbook requires LBA delivery or LBA-supervised CBAA delivery — confirm network credentialing status.
- **PA confirmation in writing:** ABA-specific PA requirements aren't published — confirm per case via Member Services (716-250-7183 / 1-833-891-9372) or the provider portal.
- **County/plan match:** Independent Health's MediSource footprint is Erie County — confirm the member is actually in-service-area before assuming coverage.

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

## Verification of benefits (VOB) data

How Independent Health (NY Medicaid) ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 00436
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** Carelon Behavioral Health manages general BH for MediSource per the plan's own policy page, but ABA appears to sit outside that delegation and be administered by Independent Health directly (inferred from handbook structure, not a single explicit provider-facing statement)

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes (service category, not broken out per CPT code) — "Independent Health covers..." language in the MediSource handbook, apart from the Carelon-branded BH section | — | — | home, other setting (named generically; no POS codes given) | — | — |
| 97152 | Yes (service category, not broken out per CPT code) — "Independent Health covers..." language in the MediSource handbook, apart from the Carelon-branded BH section | — | — | home, other setting (named generically; no POS codes given) | — | — |
| 97153 | Yes (service category, not broken out per CPT code) — "Independent Health covers..." language in the MediSource handbook, apart from the Carelon-branded BH section | — | — | home, other setting (named generically; no POS codes given) | — | — |
| 97154 | Yes (service category, not broken out per CPT code) — "Independent Health covers..." language in the MediSource handbook, apart from the Carelon-branded BH section | — | — | home, other setting (named generically; no POS codes given) | — | — |
| 97155 | Yes (service category, not broken out per CPT code) — "Independent Health covers..." language in the MediSource handbook, apart from the Carelon-branded BH section | — | — | home, other setting (named generically; no POS codes given) | — | — |
| 97156 | Yes (service category, not broken out per CPT code) — "Independent Health covers..." language in the MediSource handbook, apart from the Carelon-branded BH section | — | — | home, other setting (named generically; no POS codes given) | — | — |
| 97157 | Yes (service category, not broken out per CPT code) — "Independent Health covers..." language in the MediSource handbook, apart from the Carelon-branded BH section | — | — | home, other setting (named generically; no POS codes given) | — | — |
| 97158 | Yes (service category, not broken out per CPT code) — "Independent Health covers..." language in the MediSource handbook, apart from the Carelon-branded BH section | — | — | home, other setting (named generically; no POS codes given) | — | — |
| 0362T | Yes (service category, not broken out per CPT code) — "Independent Health covers..." language in the MediSource handbook, apart from the Carelon-branded BH section | — | — | home, other setting (named generically; no POS codes given) | — | — |
| 0373T | Yes (service category, not broken out per CPT code) — "Independent Health covers..." language in the MediSource handbook, apart from the Carelon-branded BH section | — | — | home, other setting (named generically; no POS codes given) | — | — |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** Confirm whether Independent Health or Carelon actually adjudicates this code before routing — the handbook's ABA section carries no Carelon reference anywhere, unlike the general BH section, but no single provider-facing sentence states the split explicitly. Erie County (Buffalo) footprint only — not Monroe/Rochester.

### Contacts

- **Provider services phone:** 1-855-481-7038
- **Phone menu path:** Listed as "Authorizations, Referrals or Clinical Matters" (Provider Relations/Contracting uses a separate line, 1-844-265-7592).
- **Portal:** [Independent Health (myIH)](https://www.myih.com)

Questions to ask on a verification call:

- Does ABA route through Carelon Behavioral Health or bill directly to Independent Health's own payer ID (00436) — what payer ID should we use for eligibility/claims?
- Is prior authorization required for ABA codes, and if so what is the process?
- What are the per-code unit/hour caps and cap period for ABA services?
- Is ABA billable via telehealth, and if so what modifier/POS applies?
- What billing modifiers does Independent Health require for LBA vs. CBAA-delivered services?
- Is the ABA cost share a copay or coinsurance, charged per-visit or per-day, and does the deductible apply?
- Does Independent Health support real-time 270/271 eligibility responses for payer ID 00436?

### VOB data sources

- 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.independenthealth.com/providers/policies-and-guidelies/behavioral-health-for-state-products (accessed 2026-07-23)
- https://www.independenthealth.com/content/dam/independenthealth/individuals-and-families/find-a-health-plan/documents/state/medisource-member-handbook.pdf (accessed 2026-07-23)
- https://www.caqh.org/sites/default/files/CAQH%20CORE%20Eligibility%20Benefits%20(270_271)%20Data%20Content%20Rule%20vEB2.0.pdf (accessed 2026-07-23)

## Common questions

### Does Independent Health cover ABA therapy?

Yes — its MediSource Medicaid plan covers ABA for members under 21 with ASD and/or Rett syndrome, delivered by an LBA or an LBA-supervised CBAA, per the current member handbook.

### Does Carelon handle ABA authorizations for Independent Health?

Carelon manages general behavioral health for Independent Health's state products, but ABA appears to be administered by Independent Health directly based on how the member handbook separates the two benefits — not confirmed in one explicit sentence, so verify with Provider Services before routing a case.

### Is Independent Health available in Rochester/Monroe County?

No — the state's Medicaid Managed Care enrollment tables list Independent Health only under Erie County (Buffalo), not Monroe County.

## Primary sources

1. [Independent Health — Behavioral Health for State Products](https://www.independenthealth.com/providers/policies-and-guidelies/behavioral-health-for-state-products)
2. [Independent Health MediSource Member Handbook (2026)](https://www.independenthealth.com/content/dam/independenthealth/individuals-and-families/find-a-health-plan/documents/state/medisource-member-handbook.pdf)
3. [Independent Health — MediSource plan page](https://www.independenthealth.com/individuals-and-families/find-a-health-plan/state-plans/medisource)
4. [Independent Health — MediSource Connect (HARP) plan page](https://www.independenthealth.com/individuals-and-families/find-a-health-plan/state-plans/medisource-connect)
5. [Independent Health/Beacon Provider FAQ Tip Sheet (2016)](https://www.independenthealth.com/content/dam/independenthealth/provider/Policies-and-Guidelines/documents/IHBeaconProviderFAQTipSheet.pdf)
6. [NYS DOH Medicaid Managed Care Enrollment Report, July 2026](https://www.health.ny.gov/health_care/managed_care/reports/enrollment/monthly/2026/docs/en07_26.pdf)
7. [eMedNY ABA Provider Policy Manual (state baseline)](https://www.emedny.org/ProviderManuals/ABA/PDFS/ABA_Policy.pdf)
8. [eCFR — 42 CFR 438.210(d), timeframe for decisions](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
9. [eMedNY Information for All Providers — General Policy (Version 2022-2)](https://www.emedny.org/ProviderManuals/AllProviders/PDFS/Information_for_All_Providers-General_Policy.pdf)
10. [NYS Medicaid Managed Care Model Contract (March 1, 2019), Appendix F §3 and §3.7](https://www.health.ny.gov/health_care/managed_care/docs/medicaid_managed_care_fhp_hiv-snp_model_contract.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.