---
title: "UnitedHealthcare / Optum ABA coverage in Arizona: the intake guide."
url: "https://carelu.com/payers/unitedhealthcare-arizona"
markdown_url: "https://carelu.com/payers/unitedhealthcare-arizona.md"
state: AZ (Arizona)
payer: UnitedHealthcare / Optum in Arizona
kind: Commercial insurance
description: "How UnitedHealthcare / Optum covers ABA for Arizona families — the national clinical policy, prior authorization, Optum's Arizona state-mandate entry reflecting SB 1590's cap repeal, A.R.S. § 32-2091 licensure, and what intake should verify."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

# UnitedHealthcare / Optum ABA coverage in Arizona: the intake guide.

_Payer Guide · UnitedHealthcare · Arizona · Last updated September 2026 · 9 primary sources_

> BH803ABASCC + Optum's AZ state-mandate entry reflecting SB 1590's cap repeal.

For an intake team in Arizona, a UnitedHealthcare card means three layers at once: the carrier's national clinical policy, Arizona's autism insurance mandate (Steven's Law, its dollar caps freshly repealed by SB 1590), and the plan's funding type deciding which of the two actually binds. This guide stacks them in order — and UHC is the one national carrier whose Optum criteria carry an explicit Arizona commercial entry.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — step 1 of Optum's two-step authorization (assessment auth via Provider Express) [1]
- **Prior auth for treatment**: Required — step 2 (treatment auth); reviews every 4–6 months [1]
- **Autism diagnosis required?**: Yes — DSM-5-TR ASD confirmed with a validated tool (ADI-R, ADOS-2, etc.) [1]

## At a glance

- **Covers ABA?:** Yes — for ASD, per the national UnitedHealthcare policy
- **State mandate:** Steven's Law (A.R.S. § 20-826.04 and three parallel sections)
- **Mandate caps:** NONE — the $50K/$25K annual caps were repealed by SB 1590 (2025)
- **Mandate age:** No explicit age limit remains — the age tiers lived in the repealed cap subsection
- **Exempt from mandate:** Individual & small-employer policies; self-funded ERISA
- **Licensure:** AZ Licensed Behavior Analyst (A.R.S. § 32-2091, Board of Psychologist Examiners)

## The national policy, applied in Arizona

UnitedHealthcare administers ABA through Optum Behavioral Health as a two-step authorization on the Provider Express portal — assessment authorized first, then treatment — under Optum's Supplemental Clinical Criteria, with continued-service reviews every 4–6 months. That clinical policy is national — what changes in Arizona is the legal floor underneath it: the state mandate below governs what fully-insured group plans must cover, while self-funded employer plans answer to ERISA and federal parity instead. Plan funding type is therefore the first fact to establish on every benefits check. The full national policy breakdown lives in our UnitedHealthcare / Optum guide; this page covers what changes in Arizona. [1]

## The Arizona mandate: Steven's Law, caps repealed

Steven's Law (HB 2847, 2008) lives in four parallel sections of the insurance code — A.R.S. §§ 20-826.04, 20-1057.11, 20-1402.03, and 20-1404.03 — covering state-regulated group coverage: large-group contracts, HMO plans, and group and blanket disability policies. Plans may not deny or limit treatment based solely on an autism spectrum disorder diagnosis, and may not exclude medically necessary behavioral therapy, which the statute defines to include ABA (discrete trial training, pivotal response training, intensive behavioral intervention), delivered or supervised by a licensed or certified provider. The headline change: SB 1590 (signed May 7, 2025) struck the dollar-cap subsection from all four sections — the old $50,000/year (under age 9) and $25,000/year (ages 9–16) behavioral-therapy maximums are repealed, taking the statute's only age tiers with them, and the ASD definition now tracks the current DSM. No annual dollar ceiling remains on any state-regulated group plan (federal parity had already made the caps largely unenforceable; SB 1590 cleaned the statute to match — do not treat the old $50K/$25K numbers as current). Exemptions: policies issued to an individual or small employer (those reach ABA via the ACA EHB benchmark instead), limited-benefit coverage, and self-funded ERISA plans. Ordinary cost sharing is still permitted. [3][4][5]

## Optum's Arizona-specific criteria

Arizona has its own entry in Optum's ABA State Mandates supplemental criteria (BH803ABASTM12026, effective January 2026): for Arizona commercial plans, Optum operationalizes SB 1590 — the repeal of the maximum benefit limits for members 16 and under and the DSM-based ASD definition. In practice that means Optum's own criteria document already reflects the cap repeal, so a UM conversation that cites the old $50K/$25K numbers is out of date on both the statute and the carrier's paperwork. [2]

## UnitedHealthcare Medicaid in Arizona

A family saying "we have UnitedHealthcare" in Arizona may actually be on the carrier's Medicaid plan — UnitedHealthcare Community Plan of Arizona, which is both an ACC plan and one of the two statewide DDD Health Plans ("DD by UHCCP"), with ABA administered by Optum under AHCCCS rules: no autism diagnosis required, no PA on 97151/97152, its own AZ treatment-request forms. Verify which line of business the card belongs to, and use the dedicated guide for the Medicaid plan. [7]

## Licensure & rates in Arizona

Arizona requires a state license to practice behavior analysis — A.R.S. § 32-2091, administered by the Arizona Board of Psychologist Examiners (behavior analysts sit under the psychology board, not a standalone board) — and BCBA certification alone is not sufficient; AHCCCS itself defines "Behavior Analyst" as a person licensed under § 32-2091. On rates: UnitedHealthcare does not publish commercial ABA fee schedules for Arizona (none of the national carriers do) — rates are contract-negotiated and live in your participating-provider agreement. Benchmark against the AHCCCS fee schedule (97153 at $17.91–$23.69 per 15-minute unit by credential tier), remembering the ABA codes live on the AHCCCS physician fee schedule, not the behavioral-health one. [6][8]

## Intake gates

The questions that decide whether a family can start with UnitedHealthcare / Optum in Arizona, and what they have to bring.

- **Diagnosis recency**: Optum's Supplemental Clinical Criteria set no recency clock on the ASD diagnosis. What they require instead is current assessment: the comprehensive diagnostic evaluation and functional assessment "form the basis for the treatment plan," baseline skills and norm-referenced measures must reflect the individual's "specific and current abilities," and continued coverage rides on documentation of movement from baseline at each 4–6 month review. [1]
- **Who may diagnose**: "A valid diagnosis of ASD (or other applicable diagnosis as required by governing laws) must be issued by a state licensed physician, psychologist, or other state licensed clinician qualified to make such diagnosis according to the diagnostic criteria based on the DSM-5-TR." The diagnosing clinician must also confirm and document the severity level. [1]
- **Diagnostic tools required**: The DSM-5-TR diagnosis and severity level must be "confirmed and documented by the diagnosing clinician using at least one clinically validated tool," on a three-tier list: first-level screening (ABC, CHAT/M-CHAT, CSBS-DP-IT Checklist, ASQ, AQ, CAST), second-level screening (CARS/CARS-2, RITA-T, STAT) and formal diagnostic tools used in a comprehensive evaluation (ADI-R, ADOS/ADOS-2, DISCO). Treatment intensity must then be set against at least one validated measurement tool — ATEC, VB-MAPP, ABLLS/ABLLS-R, AFLS, PEAK, SSIS, RBS-R, SRS, VABS or CFQL-2. [1]
- **Referral required?**: No physician referral or order is required. The front door is Optum's two-step authorization on Provider Express — "Prior authorization is required for ABA (unless otherwise specified or mandated by contract or law)" — with the diagnosis, the credentialed ABA provider and the assessment package standing in for a referral. [1]
- **Age limit** _(plan-dependent)_: Steven's Law now carries no explicit age limit: SB 1590 (signed May 7, 2025) struck the dollar-cap subsection from all four sections of the mandate, and the age tiers — under 9, and 9 through 16 — lived inside that subsection. Optum's own state-mandate entry describes the change as repealing "the maximum benefit limitations for behavioral therapy coverage for eligible persons who are 16 years old and younger." The carrier's national ABA policy adds no age bound of its own, so age comes from the benefit document, not the statute. Optum operationalises this in its own ABA State Mandates supplement, which carries an explicit Arizona Commercial entry. [3][4][1][2]
  - Ask the plan: Benefits verification on the specific plan — funding type first, then the ABA benefit terms.
- **Prior-auth decision time** _(plan-dependent)_: UHC’s 2026 commercial administrative guide says standard requests take "up to 15 calendar days" and expedited "72 hours", and asks for requests "at least 15 calendar days in advance, if possible, but must be submitted at least 5 business days before the planned service date"; ABA itself is authorized by Optum Behavioral Health, whose network manual publishes no prospective decision clock (retrospective requests are decided within 30 calendar days). So the governing clock depends on funding. For a fully insured plan issued in Arizona, A.R.S. § 20-3404 governs: urgent requests "not later than five days after the receipt of all necessary information", non-urgent "not later than fourteen days after receipt of all necessary information", with the same five/fourteen days again after the provider completes an incomplete request — and "A prior authorization request is deemed granted if a health care services plan or its utilization review agent fails to comply with the deadlines." A granted authorization cannot be rescinded after services are rendered in good faith, absent fraud. A self-funded employer plan sits outside state law and follows ERISA: a non-urgent pre-service decision "not later than 15 days after receipt of the claim by the plan", extendable once by up to 15 days; an urgent one within 72 hours; the clock starts when the request is filed, whether or not it is complete; and an urgent request to extend an approved course is decided within 24 hours if made "at least 24 hours prior to the expiration" of the current authorization. [10][11][12][13]
  - Ask the plan: At benefits verification, ask whether the plan is fully insured (a policy issued in the state) or a self-funded employer (ERISA) plan — that decides which clock applies — then ask the carrier’s behavioral health precert line its expected ABA turnaround and how early it wants the reauth.
- **Other insurance (who pays first)** _(plan-dependent)_: Arizona’s COB rule for group plans (A.A.C. R20-6-214) sets the order: the plan covering the person other than as a dependent pays first; for a dependent child, "The plan of a parent whose birthday occurs earlier in a calendar year shall cover a dependent child before" the other parent’s plan (month and day only); for separated or divorced parents, the custodial parent’s plan, then the custodial parent’s spouse’s, then the non-custodial parent’s, unless a court decree the plan knows of says otherwise. Self-funded plans follow their own plan document. UHC says "COB is administered according to the member's benefit plan and in accordance with law"; Optum’s network manual tells providers to determine other coverage, "bill the primary insurance carrier first, then notify Optum of your findings," and says it applies industry-standard COB rules and state law. Government coverage sorts itself by federal rule: a commercial plan pays before TRICARE, which is secondary to every other health plan but "In any double coverage situation involving Medicaid, CHAMPUS is always the primary payer"; CHAMPVA "is the last payer to OHI"; and Medicaid pays after all of them (42 CFR 433.139), so a child with commercial plus Medicaid needs this plan’s authorization and EOB before Medicaid will pay. [14][10][11][15][16][17]
  - Ask the plan: Collect both parents’ plans, dates of birth, and any custody decree at intake; confirm primary/secondary with each carrier’s COB unit (and whether the plan is self-funded) before the first claim.
- **Telehealth** _(ask the plan)_: Optum publishes no ABA telehealth code list in the Supplemental Clinical Criteria; it points providers to CASP's Practice Parameters for Telehealth-Implementation of Applied Behavior Analysis, Second Edition, which it describes as a resource for ABA "delivered via telehealth in a broad range of clinical settings (e.g., home, clinic, school)" and as a supplement to, not a replacement for, in-person delivery. [1]
  - Ask the plan: Optum/UnitedHealthcare provider services and the plan's telehealth reimbursement policy — confirm which ABA codes are payable remotely and with which POS before scheduling.

## Delivery and billing rules

Coverage decides whether UnitedHealthcare / Optum in Arizona 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**: Two numbers, from two documents. Clinically, "consistent with CASP standards of care, direct case supervision is required 1–2 hours for every 10 hours of direct treatment per week," with technicians under the supervision of a BCBA or licensed behavioral health clinician and parents discouraged from serving as their own child's RBT. On the claim side, the commercial reimbursement policy polices the boundary rather than a ratio: "CPT codes 97153 and 97155 may not be billed for technician training," and 97155 "should be reported only for services where the QHP is either engaged directly with the patient or is directing a technician in implementing a modified protocol with the patient" — treatment planning is indirect and not separately reimbursable. [1][9]
- **Concurrent billing (97153 + 97155)**: Yes, with a single-provider exclusion. "Can I report 97153 or 97154 with 97155 concurrently? A. Yes, as long as the criteria in the descriptors of both codes are met. A single QHP may not report 97153 or 97154 with 97155 concurrently." So the concurrency has to be two people — technician on 97153, analyst on 97155 directing them with the patient present. Separately, 97155 and 97156 may both pay on the same date of service only if the services are separate, distinct and clearly documented in the progress notes. [9]
- **Daily limits / MUEs**: Optum publishes its own per-day table on top of CMS MUEs — maximum frequency per day: 97151 32 units (8 hrs), 97152 16 (4 hrs), 97153 32 (8 hrs), 97154 18 (4.5 hrs), 97155 24 (6 hrs), 97156 16 (4 hrs), 97157 16 (4 hrs), 97158 16 (4 hrs), 0362T 16 (4 hrs), 0373T 32 (8 hrs). MUEs otherwise apply per CMS guidance, and billing above 32 units/day of 97153 "may be subject to non-reimbursement or recovery." [9]
- **Bill as provider**: One provider-level modifier per line, matching whoever actually rendered the service: HM = Registered Behavior Technician (less than bachelor's level), HN = BCaBA (bachelor's level), HO = BCBA or master's-level licensed clinician, HP = BCBA-D or doctoral-level licensed clinician. A billable ABA-supervisor service is billed with the applicable CPT code plus HO. Stacking level modifiers is a denial risk: "Billing multiple provider-level modifiers (HN, HM, HO, HP) on the same service line same service and same DOS is not appropriate and may result in claim denial." [9]
- **Place of service** _(plan-dependent)_: No POS code list is published. The clinical criteria draw the school line instead: ABA is not covered for "services that are not ABA therapy, such as 1:1 aid delivered simultaneously during classroom instruction, or services covered under the Individuals with Disabilities Education Act (IDEA)," while "school ABA services do allow for coordination of services and would cover services such as teacher training, meetings with school personnel, and observations in the school setting." [1]
  - Ask the plan: UnitedHealthcare/Optum provider services and the member's benefit document.

## What intake should collect for UnitedHealthcare / Optum in Arizona

- **Plan funding type:** Fully insured group (mandate applies) vs. self-funded ERISA (exempt) vs. individual/small-group (EHB benchmark) — it decides which rulebook governs.
- **Line of business:** Commercial vs. UnitedHealthcare Community Plan of Arizona (Medicaid/DDD) — different rules, different guide.
- **Member ID + card photo:** Enough to run a live benefits verification — the only reliable answer on limits and cost-sharing.
- **Diagnosis report:** DSM-5-TR ASD diagnosis confirmed with a validated tool (ADI-R, ADOS-2, etc.), diagnosing provider and credentials, evaluation date.

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

## Verification of benefits (VOB) data

How UnitedHealthcare / Optum in Arizona ABA benefits route and read on an eligibility check. Data last updated 2026-07-23.

### EDI routing

- **Payer ID (pVerify):** 00192 — pVerify 00192 = "United Healthcare"; UHG007 = "United Healthcare - Optum Behavioral Solutions". Note: "we have UnitedHealthcare" in AZ often means the UHC Community Plan (Medicaid/DDD) — see unitedhealthcare-community-plan-arizona.
- **Payer ID (Change Healthcare / Optum):** 87726 — 87726 is UHC's dominant national commercial ID; the AZ commercial ABA/behavioral ERA IDs are not separately published — confirm via uhcprovider.com EDI / Provider Express.
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** Optum Behavioral Health
- **BH administrator payer ID:** 87726 — Optum administers commercial ABA authorizations; claims typically route to the UHC medical ID 87726 (no two-hop on claims).
- **ABA rides on:** medical benefit
- **Two-hop verification required:** No

### How the 271 reports ABA benefits

- **ABA benefit bucket (service type code):** MH — UHC's own EDI feed (87726) formally supports MH/A4-A8 with financial detail, but whether members whose ABA benefit is carved to Optum Behavioral Health actually receive populated MH-flavor detail through this SAME feed — versus a referral/vendor-lookup stub via the guide's own documented EB*U 'vendor' segment mechanism — is not resolved by any source found this pass. Confirm via Provider Express / UHC provider services for the specific plan.
- **Deductible applies to ABA:** yes — Same open question as abaBenefitBucket — confirm whether the carved-out BH benefit populates deductible detail on this feed.
- **Cost-share type:** plan-dependent — Both copay and coinsurance are structurally supported per plan; which applies to a given member is plan-document-specific.
- **271 response quality for ABA:** high

### Code-level coverage

| Code | Covered | Prior auth | Unit cap | Place of service | Telehealth | Modifiers |
| --- | --- | --- | --- | --- | --- | --- |
| 97151 | Yes | Required — Optum two-step (assessment auth, then treatment auth); reviews every 4–6 months | — | — | — | — |
| 97152 | Yes | Required — Optum two-step (assessment auth, then treatment auth); reviews every 4–6 months | — | — | — | — |
| 97153 | Yes | Required — Optum two-step (assessment auth, then treatment auth); reviews every 4–6 months | — | — | — | — |
| 97154 | Yes | Required — Optum two-step (assessment auth, then treatment auth); reviews every 4–6 months | — | — | — | — |
| 97155 | Yes | Required — Optum two-step (assessment auth, then treatment auth); reviews every 4–6 months | — | — | — | — |
| 97156 | Yes | Required — Optum two-step (assessment auth, then treatment auth); reviews every 4–6 months | — | — | — | — |
| 97157 | Yes | Required — Optum two-step (assessment auth, then treatment auth); reviews every 4–6 months | — | — | — | — |
| 97158 | Yes | Required — Optum two-step (assessment auth, then treatment auth); reviews every 4–6 months | — | — | — | — |
| 0362T | Yes | Required — Optum two-step (assessment auth, then treatment auth); reviews every 4–6 months | — | — | — | — |
| 0373T | Yes | Required — Optum two-step (assessment auth, then treatment auth); reviews every 4–6 months | — | — | — | — |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** Verify via: Optum Provider Express — Optum's ABA State Mandates criteria carry an AZ commercial entry operationalizing SB 1590 (cap repeal), but no CPT coding mechanics; national two-step (assessment auth, then treatment). (Commercial only — for the AHCCCS plan see unitedhealthcare-community-plan-arizona.)

### Contacts

- **Provider services phone:** 1-866-209-9320 (Optum Provider Express Support Center — shared portal help desk, not an AZ-commercial-specific line)
- **Phone menu path:** For member-specific eligibility/PA, call the number on the member’s ID card or use Provider Express; no dedicated AZ-commercial ABA line is separately published.
- **Hours:** 7:00 a.m.–9:00 p.m. CT
- **Portal:** [Optum Provider Express](https://www.providerexpress.com)

Questions to ask on a verification call:

- What POS codes does Optum accept for ABA sessions (home, clinic, school, community)?
- Is telehealth allowed for ABA codes, and does it require a specific modifier?
- Is there a unit or hour cap per day or week for treatment codes, and over what period?
- What credential-tier modifiers does Optum require on ABA claims?

### 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.caqh.org/sites/default/files/CAQH%20CORE%20Eligibility%20Benefits%20(270_271)%20Data%20Content%20Rule%20vEB2.0.pdf (accessed 2026-07-23)
- https://www.uhcprovider.com/content/dam/provider/docs/public/resources/edi/EDI-270-271-Companion-Guide-005010X279A1.pdf (accessed 2026-07-23)
- https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaSCC.pdf (accessed 2026-07-23)
- https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/azaba/azABA_Provider_Orient.pdf (accessed 2026-07-23)

## Common questions

### Does UnitedHealthcare cover ABA therapy in Arizona?

Yes — under Optum's national two-step authorization policy for ASD, layered on Steven's Law for state-regulated group plans. Self-funded employer plans are exempt from the mandate, so always verify plan funding type first.

### Does Arizona still cap ABA benefits at $50,000 a year?

No — SB 1590 (signed May 7, 2025) repealed the $50,000/$25,000 annual caps, and Optum's own Arizona state-mandate entry (effective January 2026) already reflects the repeal. No annual dollar ceiling remains on any state-regulated group plan.

### What does UnitedHealthcare pay for ABA in Arizona?

Commercial ABA rates are not published — they are negotiated in your participating-provider agreement. Benchmark against the AHCCCS physician fee schedule and treat rate-setting as part of contracting.

## Primary sources

1. [Optum ABA Supplemental Clinical Criteria (BH803ABASCC)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaSCC.pdf)
2. [Optum — ABA State Mandates supplemental criteria (BH803ABASTM12026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf)
3. [SB 1590 — chaptered law (Laws 2025, ch. 142)](https://www.azleg.gov/legtext/57leg/1R/laws/0142.pdf)
4. [A.R.S. § 20-826.04 — current text](https://www.azleg.gov/ars/20/00826-04.htm)
5. [Autism Speaks — Arizona state-regulated insurance coverage](https://www.autismspeaks.org/arizona-state-regulated-insurance-coverage)
6. [A.R.S. § 32-2091 — behavior analyst licensure](https://www.azleg.gov/ars/32/02091.htm)
7. [Optum — Arizona AHCCCS Autism/ABA Program provider orientation (BH4129)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/azaba/azABA_Provider_Orient.pdf)
8. [AHCCCS — Final Public Notice, FFS rate changes 11/1/2023 (ABA codes)](https://www.azahcccs.gov/AHCCCS/Downloads/PublicNotices/rates/FinalPublicNotice_RateChanges_20231101_ABA.pdf)
9. [Optum — Applied Behavior Analysis (ABA) Reimbursement Policy, Commercial (2022RP501A)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/reimbPolicies/abaReimburs2020s.pdf)
10. [UnitedHealthcare — 2026 Care Provider Administrative Guide (Commercial, eff. 4/1/2026)](https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/2026-UHC-Administrative-Guide.pdf)
11. [Optum Behavioral Health — National Network Manual (eff. 9/1/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/adminResourcesMain/netwmanual/NNManual.pdf)
12. [A.R.S. § 20-3404 — prior authorization request deadlines (deemed granted if missed)](https://www.azleg.gov/ars/20/03404.htm)
13. [29 CFR 2560.503-1(f) — ERISA claims procedure: group health plan decision timeframes](https://www.ecfr.gov/current/title-29/section-2560.503-1)
14. [Ariz. Admin. Code R20-6-214 — coordination of benefits, order of benefit determination (Cornell LII mirror)](https://www.law.cornell.edu/regulations/arizona/Ariz-Admin-Code-SS-R20-6-214)
15. [32 CFR 199.8 — TRICARE double coverage (secondary to other plans, primary to Medicaid)](https://www.ecfr.gov/current/title-32/subtitle-A/chapter-VII/subchapter-M/part-199/section-199.8)
16. [38 CFR 17.276 — CHAMPVA is the last payer to other health insurance](https://www.ecfr.gov/current/title-38/section-17.276)
17. [42 CFR 433.139 — payment of claims involving third-party liability](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)

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.