---
title: "UnitedHealthcare / Optum ABA coverage in Maryland: the intake guide."
url: "https://carelu.com/payers/unitedhealthcare-maryland"
markdown_url: "https://carelu.com/payers/unitedhealthcare-maryland.md"
state: MD (Maryland)
payer: UnitedHealthcare / Optum in Maryland
kind: Commercial insurance
description: "How UnitedHealthcare / Optum covers ABA for Maryland families — the national clinical policy, prior authorization, Optum's published Maryland state-mandate criteria (COMAR 31.10.39.03 with 25/10 hour floors), Maryland LBA licensure, and what intake should verify."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

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

_Payer Guide · UnitedHealthcare · Maryland · Last updated September 2026 · 7 primary sources_

> Optum BH803ABASCC + a published Maryland State Mandates entry adopting the COMAR 25/10-hr floors.

For an intake team in Maryland, a UnitedHealthcare card means three layers at once: the carrier's national clinical policy, Maryland's habilitative-services mandate (Md. Code Ann., Insurance § 15-835, implemented by COMAR 31.10.39.03), and the plan's funding type deciding which of the two actually binds. UnitedHealthcare is the carrier that makes the Maryland layer easiest to enforce: Optum publishes a Maryland entry in its ABA State Mandates criteria that adopts the COMAR rules — hour floors included — for fully-insured plans. This guide stacks the layers in order.

## 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][6]
- **Prior auth for treatment**: Required — step 2 (treatment auth); reviews every 4–6 months [1][6]
- **Autism diagnosis required?**: Yes — DSM-5-TR ASD confirmed with a validated tool (ADI-R, ADOS-2, etc.) [1][6]

## At a glance

- **Covers ABA?:** Yes — for ASD, per the national UnitedHealthcare policy
- **State mandate:** Md. Ins. § 15-835 + COMAR 31.10.39.03 (habilitative services)
- **Mandate age:** Through at least the month the enrollee turns 19; hour floors span 18 months–18 years
- **Mandate floors:** No denial solely on hours up to 25 hrs/wk (18 mo–5 yrs) or 10 hrs/wk (6–18); no dollar cap
- **Optum MD criteria:** Published — BH803ABA State Mandates applies COMAR 31.10.39.03 to MD fully-insured plans
- **Licensure:** MD Licensed Behavior Analyst (Board of Professional Counselors & Therapists)

## The national policy, applied in Maryland

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 Maryland is the legal floor underneath it: the state mandate governs what fully-insured 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 Maryland. [1]

## Optum's Maryland-specific criteria: COMAR, in the carrier's own document

Maryland has its own entry in Optum's ABA State Mandates supplemental criteria (BH803ABA): for fully-insured policies in Maryland, Optum directs reviewers to use the COMAR 31.10.39.03 criteria (April 3, 2014) in place of its standard medical-necessity rules. The document reproduces the Maryland requirements — comprehensive evaluation, physician prescription with treatment goals and annual prescriber review, the no-denial floors of 25 hours/week for ages 18 months–5 years and 10 hours/week for ages 6–18 (with more when medically necessary), school allowed as a service location (though not as an IEP/IDEA obligation), licensed delivery, and the rule that ABA may not be denied as experimental. Once the mandated benefits are exhausted, Optum reverts to its standard medical-necessity policy. For intake, this is leverage: on a fully-insured UHC plan, an hours reduction below the floors contradicts the carrier's own published criteria — cite the state-mandates document, not just the regulation. [2]

## The Maryland mandate underneath

The legal base: Maryland has no standalone autism mandate — ABA rides on the habilitative-services mandate, Insurance § 15-835, which requires Maryland-regulated insurers, nonprofit health service plans, and HMOs to cover habilitative services until at least the end of the month the enrollee turns 19, with the ABA-specific medical-necessity rules delegated to the Insurance Commissioner's regulation, COMAR 31.10.39.03. Carriers aren't required to reimburse services delivered through early intervention or the schools, and self-funded ERISA plans are exempt — for those members the Optum Maryland entry doesn't apply either, and MHPAEA parity is the fallback lever. [3]

## UnitedHealthcare Medicaid in Maryland: the card that doesn't matter for ABA

A family saying "we have UnitedHealthcare" in Maryland may be on UnitedHealthcare Community Plan, a HealthChoice MCO — but that changes nothing for ABA. Maryland carves ABA out of the MCOs entirely: authorizations and claims go to Carelon Behavioral Health, the state's BHASO, under the Medicaid fee-for-service rules — use our Maryland Medicaid guide. One historical wrinkle worth knowing: Optum Maryland was the state's previous behavioral-health ASO before Carelon took over, so legacy Optum-branded Maryland ABA manuals still circulate — they are stale; Carelon's ProviderConnect is the current pipeline. [4][7]

## Licensure & rates in Maryland

Maryland has required licensure to practice behavior analysis since January 2015: the Licensed Behavior Analyst (LBA) credential, administered by the Behavior Analyst Advisory Committee of the State Board of Professional Counselors and Therapists (Health Occupations Title 17, Subtitle 6A; COMAR 10.58.16), built on current BACB certification, a qualifying master's degree, and a criminal-history check. On rates: UnitedHealthcare does not publish commercial ABA fee schedules for Maryland (none of the national carriers do) — rates are contract-negotiated and live in your participating-provider agreement. Maryland's Medicaid fee schedule (effective February 1, 2026 — e.g., 97153 at $24.41/15-min BCBA tier) is the public benchmark to negotiate against. [5]

## Intake gates

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

- **Who may diagnose**: A DSM-5-TR autism spectrum diagnosis from a state-licensed physician, psychologist, or other qualified clinician. Optum asks for the diagnosing clinician and the instrument at the assessment-authorization step, so both are intake fields. [1]
- **Diagnostic tools required**: The diagnosis must be confirmed with at least one clinically validated tool. Optum names first-level instruments — the ADI-R, the ADOS-2 and the DISCO — and accepts second-level tools including the CARS-2, the RITA-T and the STAT. Capture which instrument was used, by whom and when; “diagnosed by Dr. X” without a named tool is the most common reason an Optum assessment request stalls. [1]
- **Telehealth**: Gated on the provider, not just the code. Tele-supervision and virtual family training require the provider to be an approved Optum virtual-visits provider with a completed attestation on Provider Express, and the authorization itself must note virtual delivery. Optum frames telehealth as a supplement to in-person care rather than a replacement for it, so a request built mostly on remote hours should expect pushback. [6]
- **Age limit** _(plan-dependent)_: Two answers, and plan funding type picks between them. The carrier's national ABA policy states no age limit. Maryland's habilitative-services mandate does: for Maryland-regulated insurers, nonprofit health service plans and HMOs, habilitative services must be covered “until at least the end of the month the enrollee turns 19,” and COMAR 31.10.39.03 pins its no-denial hour floors to age bands — up to 25 hours/week for ages 18 months through 5 years and up to 10 hours/week for ages 6 through 18, with more when medically necessary. Self-funded ERISA plans are exempt from all of it, so establish funding type before quoting either bound. [3][2]
  - Ask the plan: Benefits verification on the specific plan, via the payer portal or the number on the member’s card — ask whether the plan is Maryland-regulated (an insurer, nonprofit health service plan or HMO, which the habilitative-services mandate and COMAR 31.10.39.03 age bands reach) or a self-funded ERISA plan (exempt). If it is self-funded, ask what age limit and weekly hour limit the plan document sets for ABA before you quote either bound to the family.
- **Referral required?** _(plan-dependent)_: On a fully-insured Maryland plan, yes — and it is a prescription, not a note. COMAR 31.10.39.03 conditions the mandated benefit on a comprehensive evaluation, a prescription with treatment goals from the PCP or a specialty physician, and annual review by the prescriber. Capture the prescriber and the prescription date at intake, and diary the annual renewal: a lapsed prescription is a coverage problem, not a paperwork one. Self-funded ERISA plans are outside the mandate, and for those the carrier's own authorization requirements are the only gate. [3][2]
  - Ask the plan: Benefits verification on the specific plan, via the payer portal or the number on the member’s card — confirm funding type first. On a Maryland-regulated plan, capture the prescriber and prescription date and diary the annual prescriber review COMAR 31.10.39.03 requires. On a self-funded ERISA plan, ask the carrier whether it requires a referral or prescription at all, since the mandate does not reach it and only the carrier’s own authorization rules apply.
- **Prior-auth decision time** _(plan-dependent)_: UHC notifies coverage decisions “within the time required by law,” so the clock depends on how the plan is funded. If the child’s plan is fully insured in Maryland, Insurance §15-10B-06 sets the clock: an initial request is decided “within 2 working days after receipt of the information necessary to make the determination,” “additional visits or days of care submitted as part of an existing course of treatment or treatment plan within 1 working day,” emergency requests within 24 hours, and a reviewer missing information must say so within 3 calendar days. Maryland’s teeth: “If a private review agent fails to make a determination within the time limits required under this section, the request shall be deemed approved.” Mental-health treatment plans must be accepted on the MIA uniform treatment plan form. If the employer self-funds, ERISA’s floor applies instead: pre-service decisions “not later than 15 days after receipt of the claim” (one 15-day extension allowed), urgent claims within 72 hours. Optum (UHC’s behavioral arm) sets the reauth window: call the ABA/Autism queue “no more than 30 days prior to the current approvals on file expiring,” with all clinical information ready; retrospective reviews take up to 30 calendar days. [8][9][10][6][11]
  - Ask the plan: the member services or behavioral health number on the ID card — ask whether the plan is fully insured (and in which state) or self-funded, and for its UM decision timeframes
- **Other insurance (who pays first)** _(plan-dependent)_: UHC administers COB “according to the member’s benefit plan and in accordance with law.” Optum: “You are responsible for determining if the member has other insurance coverage. If so, you should bill the primary insurance carrier first, then notify Optum of your findings”; as secondary, payment goes up to Optum’s contracted rate and you may not balance-bill. Maryland has not yet adopted a COB regulation: the Insurance Administration says contract COB provisions “have historically been reviewed for consistency with the NAIC Model, but the Model has not been formally adopted to date,” and its draft COMAR 31.10.53 (comments closed August 2026) would codify the NAIC birthday rule (“The plan of the parent whose birthday falls earlier in the calendar year is the primary plan”) and exclude Medicaid from the definition of a plan — so Maryland Medicaid always pays after the commercial plan. [8][11][12][13]
  - Ask the plan: the carrier’s eligibility response (Availity or the ID-card number) for an other-insurance record, and both parents’ birth dates and custody arrangements at intake; a self-funded plan follows its own plan document
- **Diagnosis recency** _(ask the plan)_: Optum publishes no recency rule for the ASD diagnosis in its Supplemental Clinical Criteria as cited here; what it does set is a review cadence downstream — continued-service reviews every 4–6 months requiring updated standardized adaptive measures and progress measured the same way as baseline. [1]
  - Ask the plan: Optum provider services or the assessment-authorization request on Provider Express — ask whether an evaluation of this age will be accepted before scheduling.

## Delivery and billing rules

Coverage decides whether UnitedHealthcare / Optum in Maryland 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**: Optum's Supplemental Clinical Criteria set supervision at 1–2 hours per 10 hours of direct treatment, with a floor of at least one hour of 97155 per case per month. In Maryland the supervising analyst must additionally hold the state Licensed Behavior Analyst credential, required to practice behavior analysis since January 2015. [1][5]
- **Concurrent billing (97153 + 97155)**: Permitted in three named pairs: supervision alongside direct care (97153 + 97155), group oversight (97154 + 97155), and parent training alongside direct care (97153 + 97156). Not covered at all: team meetings without the member present, 1:1 classroom aides, and services owed under IDEA. [1]
- **Place of service**: Optum's exclusions are the operative setting rule: team meetings without the member, 1:1 classroom aides, and any service owed under IDEA are not covered, which makes the school and IEP picture a coverage question rather than a background one. Optum's Maryland State Mandates entry goes further in the member's favour for fully-insured plans — it reproduces COMAR's allowance of school as a service location, while keeping IDEA/IEP obligations outside the benefit. [1][2]
- **Daily limits / MUEs** _(ask the plan)_: Optum does not authorize against a per-day unit ceiling; it authorizes in four code clusters — assessment (97151, 97152), direct care (97153, 97154), multi-staff (0362T, 0373T) and QHP services (97155–97158) — and units flex within a cluster without a new authorization. The number that actually bites runs the other way: utilization below 80 percent of authorized hours over a two-week window draws scrutiny at review. [1]
  - Ask the plan: The authorization letter itself on Provider Express, and Optum provider services — ask whether any per-day MUE applies to this plan on top of the cluster structure.
- **Session-note signature** _(ask the plan)_: Not published in the Supplemental Clinical Criteria. What Optum specifies is the review packet rather than the session note: continued-service reviews every 4–6 months want progress documented per targeted behavior using the same measurement methods as baseline, mastered-program rates, change scores and updated standardized adaptive measures. Who signs an individual session note, and by when, is not stated. [1]
  - Ask the plan: Optum provider services, or your Provider Express network manager — ask for the documentation standard applied at audit.
- **Bill as provider** _(ask the plan)_: Not published in the Supplemental Clinical Criteria. Optum authorizes by code cluster and names a QHP services cluster (97155–97158) distinct from the direct-care cluster (97153, 97154), which implies a credential split on the rendering line but does not state whose NPI carries a technician-delivered 97153 claim or which degree-level modifiers apply. [1]
  - Ask the plan: Optum provider services or the authorization letter on Provider Express — confirm the rendering-versus-billing NPI convention and any required modifiers before the first claim.

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

- **Plan funding type:** Fully insured (COMAR floors + Optum's MD criteria apply) vs. self-funded ERISA (exempt) — it decides which rulebook governs.
- **Line of business:** Commercial UHC vs. UnitedHealthcare Community Plan (Medicaid) — Medicaid ABA goes to Carelon, not UHC/Optum at all.
- **ABA prescription + goals:** COMAR requires a prescription with treatment goals from the PCP or a specialty physician, reviewed annually — capture the prescriber and date.
- **Member ID + card photo:** Enough to run a live benefits verification — the only reliable answer on limits and cost-sharing.
- **Diagnosis report + testing:** DSM-5-TR ASD diagnosis confirmed with a validated tool (ADI-R, ADOS-2, etc.) — Optum asks for the instrument.

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

## Verification of benefits (VOB) data

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

### EDI routing

- **Payer ID (Availity):** 87726
- **Payer ID (Change Healthcare / Optum):** 87726 — One UHC row in the Optum/UHC payer list carried an unexplained 'MD / MAMP' annotation alongside the shared 87726 ID — meaning and effect on routing not confirmed this pass.
- **Supports 270/271 eligibility:** Yes
- **Real-time eligibility:** Yes
- **Behavioral health administrator:** Optum Behavioral Health
- **BH administrator payer ID:** 87726

### 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 — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 32 units/day (≤8 hrs) per day | — | — | HN, HO, HP |
| 97152 | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 16 units/day (≤4 hrs) per day | — | — | HN, HM, HO, HP |
| 97153 | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 32 units/day (≤8 hrs) per day | — | — | HN, HM, HO, HP |
| 97154 | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 18 units/day (≤4.5 hrs) per day | — | — | HN, HM, HO, HP |
| 97155 | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 24 units/day (≤6 hrs) per day | — | — | HN, HO, HP |
| 97156 | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 16 units/day (≤4 hrs) per day | — | — | HN, HO, HP |
| 97157 | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 16 units/day (≤4 hrs) per day | — | — | HN, HO, HP |
| 97158 | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 16 units/day (≤4 hrs) per day | — | — | HN, HO, HP |
| 0362T | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 16 units/day (≤4 hrs) per day | — | — | — |
| 0373T | Yes | Required — step 1 of Optum's two-step authorization (assessment, then treatment); reviews every 4–6 months | 32 units/day (≤8 hrs) per day | — | — | — |

Code notes:

- **97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T, 0373T:** Unit caps and modifiers sourced from Optum's national ABA Reimbursement Policy (2022RP501A) — the Supplemental Clinical Criteria contains no CPT codes at all; applied here as 'inferred' absent a confirmed Maryland-specific override. Optum's BH803ABA State Mandates supplement reproduces the COMAR 31.10.39.03 hour floors for fully-insured Maryland plans (25 hrs/wk ages 18mo–5, 10 hrs/wk 6–18) — a mandate floor, not a per-code cap, so it doesn't resolve this field. Verify via: Provider Express / UHC provider services.

### Contacts

- **Portal:** [Provider Express](https://www.providerexpress.com)

Questions to ask on a verification call:

- Which places of service (home, office, school, telehealth) are authorized for ABA under this plan?
- Is telehealth allowed for any ABA codes, and which modifier (GT or 95) applies?
- Since UHC medical claims and Optum Behavioral Health share the same payer ID (87726), how should our clearinghouse distinguish ABA/behavioral claims from medical claims for routing?
- Is a two-hop authorization/eligibility process required between UHC and Optum Behavioral Health for ABA, or is it handled directly on one system?
- Can you confirm the current daily unit caps per code (97151–97158, 0362T, 0373T) for this specific plan, since Optum's national reimbursement policy is being used as a proxy?
- What is the direct phone number for ABA benefits and prior-authorization verification, since none is published on Provider Express?

### VOB data sources

- https://essentials.availity.com/availity/documents/payer_list_wShortNames.pdf (accessed 2026-07-23; source document older than 18 months)
- https://www.uhcprovider.com/content/dam/provider/docs/public/resources/edi/Payer-List-UHC-Affiliates-Strategic-Alliances.pdf (accessed 2026-07-23)
- https://pverify.com/payer-list/ (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/guidelines/reimbPolicies/abaReimburs2020s.pdf (accessed 2026-07-23)
- https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf (accessed 2026-07-23)
- https://public.providerexpress.com/content/ope-provexpr/us/en/contact-us.html (accessed 2026-07-23)
- https://public.providerexpress.com/content/ope-provexpr/us/en/admin-resources/prior-auth-info.html (accessed 2026-07-23)

## Common questions

### Does UnitedHealthcare cover ABA therapy in Maryland?

Yes — under Optum's national two-step authorization policy for ASD, and for fully-insured Maryland plans Optum's own State Mandates document applies the COMAR 31.10.39.03 criteria, including the 25 and 10 hour/week no-denial floors. Self-funded employer plans follow the standard national policy instead.

### What does the Maryland mandate require for ABA?

For fully-insured plans: habilitative-services coverage through at least the month the enrollee turns 19, no denial of ABA solely on prescribed hours up to 25 hrs/week (ages 18 months–5) or 10 hrs/week (ages 6–18), no experimental/investigational denials, and no dollar cap — entered via a comprehensive evaluation plus a physician prescription reviewed annually. Optum reproduces these criteria in its own published document.

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

Commercial ABA rates are not published — they are negotiated in your participating-provider agreement. Benchmark against Maryland Medicaid's February 2026 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 BH803ABA — ABA State Mandates supplemental criteria (Maryland entry)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf)
3. [Md. Insurance Article § 15-835 (Maryland General Assembly)](https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gin&section=15-835&enactments=false)
4. [MDH HealthChoice — Behavioral Health Coverage (carve-out)](https://health.maryland.gov/mmcp/healthchoice/Pages/BehavioralHealthCoverage.aspx)
5. [MDH Board of Professional Counselors & Therapists — Behavior Analyst License](https://health.maryland.gov/bopc/pages/analysts.aspx)
6. [Optum ABA FAQ (Provider Express)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaFAQ.pdf)
7. [MDH HealthChoice MCO Comparison Chart (UHC Community Plan roster entry)](https://health.maryland.gov/mmcp/healthchoice/Documents/hc-mco-comparison-chart.pdf)
8. [2026 UnitedHealthcare Care Provider Administrative Guide (eff. April 1, 2026)](https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/2026-UHC-Administrative-Guide.pdf)
9. [Md. Code, Insurance §15-10B-06 — private review agent determinations](https://mgaleg.maryland.gov/mgawebsite/Laws/StatuteText?article=gin&section=15-10B-06&enactments=false)
10. [eCFR — 29 CFR 2560.503-1(f)(2), ERISA claims procedure timeframes](https://www.ecfr.gov/current/title-29/subtitle-B/chapter-XXV/subchapter-F/part-2560/section-2560.503-1)
11. [Optum National Network Manual (eff. Sept. 1, 2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/adminResourcesMain/netwmanual/NNManual.pdf)
12. [Maryland Insurance Administration — Regulatory Activity (NAIC COB model not yet adopted)](https://insurance.maryland.gov/Pages/newscenter/RegulatoryActivity.aspx)
13. [MIA draft COMAR 31.10.53 Coordination of Benefits (posted July 2026)](https://insurance.maryland.gov/Documents/newscenter/legislativeinformation/3.10.53-Draft-712026.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.