---
title: "UnitedHealthcare / Optum ABA coverage in Utah: the intake guide."
url: "https://carelu.com/payers/unitedhealthcare-utah"
markdown_url: "https://carelu.com/payers/unitedhealthcare-utah.md"
state: UT (Utah)
payer: UnitedHealthcare / Optum in Utah
kind: Commercial insurance
description: "How UnitedHealthcare / Optum covers ABA for Utah families — the national clinical policy, prior authorization, the Utah Code § 31A-22-642 mandate (markets, ages, caps, exemptions), Utah behavior-analyst licensure, and what intake should verify."
last_reviewed: September 2026
vob_data_updated: 2026-07-23
---

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

_Payer Guide · UnitedHealthcare · Utah · Last updated September 2026 · 6 primary sources_

> Optum Supplemental Clinical Criteria (BH803ABASCC) + the Utah Code § 31A-22-642 mandate layer.

For an intake team in Utah, a UnitedHealthcare card means three layers at once: the carrier's national clinical policy, Utah's autism insurance mandate (Utah Code § 31A-22-642), and the plan's market segment and funding type deciding which of the two actually binds. This guide stacks them in order — and in Utah, the market-segment question comes first, because the mandate covers individual and large-group plans but not small group.

## 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:** Utah Code § 31A-22-642
- **Mandate markets:** Individual + large group only — small group NOT covered
- **Mandate age:** No age limit (plans entered/renewed on or after 1/1/2020)
- **Mandate caps:** No hour limit since 2020; 600 hr/yr floor on legacy pre-2020 plans
- **Exempt from mandate:** Small group plans; self-funded ERISA
- **Licensure:** UT Licensed Behavior Analyst (DOPL, Utah Code 58-61 Part 7)

## The national policy, applied in Utah

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. Notably, Utah has no entry in Optum's ABA State Mandates supplemental criteria (the January 2026 edition lists 14 states — Utah is not among them), so Utah commercial ABA runs on Optum's standard national criteria plus the state mandate below. The mandate governs what individual and large-group fully-insured plans must cover, while small-group and self-funded plans answer to the plan document and federal parity instead. Market segment and plan funding type are therefore the first facts to establish on every benefits check. The full national policy breakdown lives in our UnitedHealthcare / Optum guide; this page covers what changes in Utah. [1][2]

## The Utah mandate: what it guarantees (and doesn't)

Utah Code § 31A-22-642 requires coverage for the diagnosis and treatment of autism spectrum disorder in the individual and large-group markets — small group plans are not named by the statute, making market segment the load-bearing question in Utah, even ahead of funding type. For plans entered or renewed on or after January 1, 2020 there is no age limit and no cap on covered ABA hours; the older 600-hours-a-year floor and the ages-2-to-under-10 window govern only legacy pre-2020 plans. The statute has operational teeth, too: the treatment plan is due to the insurer within 14 business days of starting treatment, the insurer may review it at most once every 3 months, and plan networks must include both board certified behavior analysts and qualified licensed mental health providers. Its diagnosis definition is strict — a board-certified neurologist, psychiatrist, or pediatrician with ASD experience, or an experienced licensed psychologist. Self-funded ERISA plans are exempt by federal preemption, and MHPAEA supplies the parity floor for group plans. New from the 2026 amendment: beginning before July 1, 2027, every health benefit plan must report autism-assessment wait times, whether it imposes PA on assessment or treatment, and ABA utilization to the Utah Insurance Department annually — with public website disclosure of which plans reimburse non-physician therapists from September 1, 2027. Insurer PA behavior in Utah is about to become public record. [3][6]

## UnitedHealthcare and Utah Medicaid: no ACO, and a PMHP that doesn't touch ABA

UnitedHealthcare holds no Utah Medicaid ACO contract, so unlike most states there is no UHC Community Plan to confuse a card with. The one place the name appears on the Medicaid side is United Behavioral Health (Optum), listed among Utah's Prepaid Mental Health Plan contractors — but PMHPs cover inpatient and outpatient mental health and SUD services only, and ABA is carved out of Utah managed care entirely to state fee-for-service. If a Utah family turns out to be on Medicaid, their ABA runs through Utah Medicaid FFS regardless of any plan name — use our Utah Medicaid guide. [5]

## Licensure & rates in Utah

Utah requires a license to practice behavior analysis: the Licensed Behavior Analyst (LBA) and Licensed Assistant Behavior Analyst (LABA) credentials under the Behavior Analyst Licensing Act (Utah Code Title 58, Chapter 61, Part 7), administered by the Division of Professional Licensing (DOPL). Behavior technicians work as certified paraprofessionals under QHP supervision rather than as licensees. On rates: UnitedHealthcare does not publish commercial ABA fee schedules for Utah (none of the national carriers do) — rates are contract-negotiated and live in your participating-provider agreement. Utah does give you a public benchmark, though: the Medicaid PRISM rates effective 7/1/2026 pay $19.67 per 15-minute unit on 97153 and $37.51 on 97151/97155/97156. [4]

## Intake gates

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

- **Age limit**: Optum's criteria set no age bound — the gate is a valid ASD diagnosis — and Utah has no entry in Optum's ABA State Mandates supplemental criteria (January 2026 edition), so Utah commercial ABA runs on the standard national criteria. In Utah the legal floor is Utah Code § 31A-22-642: no age limit and no cap on covered ABA hours for individual and large-group plans entered or renewed on or after 1/1/2020 (the 600-hours-a-year floor and the ages-2-to-under-10 window govern only legacy pre-2020 plans), the treatment plan due to the insurer within 14 business days of starting treatment, and insurer review at most once every 3 months. Small-group plans are not named by the statute and self-funded ERISA plans are exempt, so market segment is the load-bearing question. [1][2][3]
- **Diagnosis recency**: Optum's criteria set no recency window on the ASD diagnosis. Currency is tested on the treatment side instead: continued-service reviews every 4 to 6 months against updated standardized, norm-referenced adaptive measures. [1]
- **Who may diagnose**: A valid ASD diagnosis (or other applicable diagnosis required by governing law) issued by a state licensed physician, psychologist, or other state licensed clinician qualified to make that diagnosis under DSM-5-TR criteria, with the DSM-5 diagnosis and severity level confirmed and documented by the diagnosing clinician. The Utah mandate's own diagnosis definition is strict and applies to plans it reaches: a board-certified neurologist, psychiatrist or pediatrician with ASD experience, or an experienced licensed psychologist. [1][3]
- **Diagnostic tools required**: At least one clinically validated tool must confirm the diagnosis and severity level. Optum groups them: first-level screeners (ABC, CHAT/M-CHAT, CSBS-DP-IT, ASQ, AQ, CAST), second-level screeners and diagnostic aids (CARS/CARS-2, RITA-T, STAT), and formal diagnostic tools used in a comprehensive diagnostic evaluation (ADI-R, ADOS/ADOS-2, DISCO). Treatment intensity must separately be set from at least one validated measurement tool — ATEC, VB-MAPP, ABLLS/ABLLS-R, AFLS, PEAK, SSIS, RBS-R, SRS, Vineland (VABS) or CFQL-2 — plus norm-referenced instruments comparing the individual to age-matched neurotypical peers. [1]
- **Referral required?**: Optum imposes no referral or physician order. Prior authorization is the gate — a two-step process on Provider Express, assessment authorized first and then treatment — unless otherwise specified or mandated by contract or law. The Utah mandate adds the 14-business-day treatment-plan deadline after treatment starts. [1][3]
- **Telehealth**: Optum treats telehealth as an available modality, citing practice parameters for telehealth implementation of ABA and noting delivery across a broad range of clinical settings (home, clinic, school) — but the telehealth options are intended to supplement, not supplant, in-person service. [1]
- **Prior-auth decision time**: UnitedHealthcare publishes its own commercial clock: "Standard requests: up to 15 calendar days"; "Expedited requests: 72 hours"; "We may extend this time if we need additional information." Submit "at least 15 calendar days in advance, if possible, but … at least 5 business days before the planned service date." ABA requests route to Optum (Provider Express, AutismABA), where "All services require prior approval"; Optum's ABA FAQ says to request a continuation "no more than 30 days prior to the current approvals on file expiring" (that FAQ dates from October 2021). Utah requires fully insured plans' procedures to "comply with this rule, 29 CFR 2560.503-1, and 45 CFR 147.136" (R590-261-4), and self-funded plans follow 29 CFR 2560.503-1 directly, so through 2026 the ceiling is the same either way: a pre-service decision "not later than 15 days after receipt of the claim" (one 15-day extension) and 72 hours for urgent care. From January 1, 2027 Utah Code 31A-22-650 tightens insurers (fully insured only) to "no later than seven calendar days after the day on which the insurer receives all necessary information," and 72 hours for urgent care. Where state law is stricter than UHC's 15 days, the law wins for fully insured members. [7][8][9][10][11]
- **Other insurance (who pays first)**: UnitedHealthcare: "COB is administered according to the member's benefit plan and in accordance with law. We accept secondary claims electronically," and "If COB caused a delay, you have 90 days from the date of the primary carrier Explanation of Benefits to submit." For ABA through Optum: "bill the primary insurance carrier first, then notify Optum of your findings"; Optum processes "using industry-wide coordination of benefits (COB) standards and in accordance with benefit contracts and applicable state laws." Utah's COB rule (R590-131-6) governs fully insured plans: for a child whose parents are married or living together, "the plan of the parent whose birthday falls earlier in the calendar year is the primary plan" (same birthday: the plan that has covered the parent longest); a court order stating otherwise controls. Self-funded plans follow their plan document. If another payer needs a UHC denial to pay, Optum's FAQ says to "Call the number on the back of the member's insurance card to request a denial." If the child also has Medicaid, this plan pays first: Medicaid is payer of last resort (42 CFR 433.139) — bill here, then send the EOB or denial to Medicaid, and get Medicaid's own prior auth too if the state requires it. TRICARE is secondary to this plan ("TRICARE shall be last pay," 32 CFR 199.8), and "CHAMPVA is the last payer to OHI" (38 CFR 17.276(d)). [7][12][8][13][14][15][16]

## Delivery and billing rules

Coverage decides whether UnitedHealthcare / Optum in Utah 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**: Consistent with CASP standards of care, direct case supervision is required at 1 to 2 hours for every 10 hours of direct treatment per week. Technicians must work under the applicable supervision of a BCBA or licensed behavioral health clinician and should be RBTs or another appropriately certified behavior technician as allowable by state mandate; a BCaBA or non-licensed individual works under the direct supervision of a BCBA or licensed behavioral health clinician who takes responsibility for the individual's care. Where significant challenging behaviors are present, a higher staff-to-patient ratio and on-site direction by the supervisor may be needed. In Utah the supervising analyst must hold a DOPL licence under Utah Code 58-61 Part 7. [1][4]
- **Daily limits / MUEs**: No per-day unit ceiling is published. Optum frames total intensity as direct plus indirect services (caregiver training and supervision included), increased or decreased on the individual's response to treatment. Under the Utah mandate there is no hour cap for individual and large-group plans entered or renewed since 1/1/2020. [1][3]
- **Place of service**: ABA must be provided at the least restrictive, most clinically appropriate level. The school boundary is explicit: ABA is not covered for services that are not ABA therapy, such as a 1:1 aide delivered simultaneously during classroom instruction, or for services covered under IDEA — but school ABA does cover coordination of services, including teacher training, meetings with school personnel, and observations in the school setting, and the treatment plan must be coordinated with the school and any applicable IFSP or IEP. [1]
- **Bill as provider** _(plan-dependent)_: Optum defines who may render — a master's- or doctoral-level BCBA, a licensed behavioral health clinician attested and credentialed to provide ABA, or a BCaBA or non-licensed technician under the direct supervision of one of those — but publishes no rendering-versus-supervising NPI rule. In Utah, ABA is carved out of Medicaid managed care entirely, so a UnitedHealthcare name on the Medicaid side (United Behavioral Health as a Prepaid Mental Health Plan contractor) never touches ABA. [1]
  - Ask the plan: Optum provider services via Provider Express and the participating-provider agreement — claim-attribution rules are contractual.
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: Optum/UnitedHealthcare reimbursement policy via Provider Express, or the participating-provider agreement. [1]
- **Session-note signature** _(ask the plan)_: Optum specifies the content that must be documented — goals and objectives, baseline behaviors, frequency, intensity, duration and progress-measurement method for each intervention, the percentage of planned sessions attended, and progress against standardized norm-referenced adaptive measures — but does not state who must sign a session note or when. [1]
  - Ask the plan: Optum provider services via Provider Express — the supplemental clinical criteria carry no signature standard.

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

- **Market segment + funding type:** Individual or large group fully-insured (mandate applies) vs. small group or self-funded ERISA (exempt) — in Utah this decides everything. Ask for the employer and check the card.
- **Commercial vs. Medicaid:** No UHC Medicaid ACO exists in Utah — a Medicaid family's ABA goes to Utah Medicaid FFS, a different guide entirely.
- **Member ID + card photo:** Enough to run a live benefits verification — the only reliable answer on limits and cost-sharing.
- **Diagnosis report + validated tool:** Optum wants DSM-5-TR ASD confirmed with a validated instrument (ADI-R, ADOS-2, etc.); the mandate separately names diagnosing-provider credentials.
- **Treatment start date:** The mandate's treatment plan is due to the insurer within 14 business days of starting treatment — put the clock on the calendar.

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

## Verification of benefits (VOB) data

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

### EDI routing

- **Payer ID (pVerify):** 00192
- **Payer ID (Availity):** 87726 — Availity "87726 UNITED HEALTHCARE" is confirmed present but the fetched Availity list carries an "As of 08/08/2012" footer — inferred pending reconfirmation against a current Availity export.
- **Payer ID (Change Healthcare / Optum):** 87726 — Carried from the same 2012 Availity snapshot; confirm via the Optum/Change Healthcare payer finder.
- **Supports 270/271 eligibility:** Yes
- **Behavioral health administrator:** Optum Behavioral Health

### 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 ABA two-step authorization via Provider Express (assessment, then treatment); continued-service reviews every 4-6 months per the corpus prose (cadence not restated in the cited SCC). | 32 units/day (<=8 hrs) per day | — | — | HN, HO, HP |
| 97152 | Yes | Required — Optum ABA two-step authorization via Provider Express (assessment, then treatment); continued-service reviews every 4-6 months per the corpus prose (cadence not restated in the cited SCC). | 16 units/day (<=4 hrs) per day | — | — | HN, HM, HO, HP |
| 97153 | Yes | Required — Optum ABA two-step authorization via Provider Express (assessment, then treatment); continued-service reviews every 4-6 months per the corpus prose (cadence not restated in the cited SCC). | 32 units/day (<=8 hrs) per day | — | — | HN, HM, HO, HP |
| 97154 | Yes | Required — Optum ABA two-step authorization via Provider Express (assessment, then treatment); continued-service reviews every 4-6 months per the corpus prose (cadence not restated in the cited SCC). | 18 units/day (<=4.5 hrs) per day | — | — | HN, HM, HO, HP |
| 97155 | Yes | Required — Optum ABA two-step authorization via Provider Express (assessment, then treatment); continued-service reviews every 4-6 months per the corpus prose (cadence not restated in the cited SCC). | 24 units/day (<=6 hrs) per day | — | — | HN, HO, HP |
| 97156 | Yes | Required — Optum ABA two-step authorization via Provider Express (assessment, then treatment); continued-service reviews every 4-6 months per the corpus prose (cadence not restated in the cited SCC). | 16 units/day (<=4 hrs) per day | — | — | HN, HO, HP |
| 97157 | Yes | Required — Optum ABA two-step authorization via Provider Express (assessment, then treatment); continued-service reviews every 4-6 months per the corpus prose (cadence not restated in the cited SCC). | 16 units/day (<=4 hrs) per day | — | — | HN, HO, HP |
| 97158 | Yes | Required — Optum ABA two-step authorization via Provider Express (assessment, then treatment); continued-service reviews every 4-6 months per the corpus prose (cadence not restated in the cited SCC). | 16 units/day (<=4 hrs) per day | — | — | HN, HO, HP |
| 0362T | Yes | Required — Optum ABA two-step authorization via Provider Express (assessment, then treatment); continued-service reviews every 4-6 months per the corpus prose (cadence not restated in the cited SCC). | 16 units/day (<=4 hrs) per day | — | — | — |
| 0373T | Yes | Required — Optum ABA two-step authorization via Provider Express (assessment, then treatment); continued-service reviews every 4-6 months per the corpus prose (cadence not restated in the cited SCC). | 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 Optum Supplemental Clinical Criteria contains no CPT codes at all; applied here absent a confirmed Utah-specific override. Utah has no entry in Optum's ABA State Mandates supplemental criteria (Jan 2026). Verify via: Provider Express / UHC provider services.

### Contacts

- **Provider services phone:** 1-877-614-0484 (Provider Services — credentialing, contracting, network status, provider demographics)
- **Phone menu path:** This line covers credentialing/contracting/demographics, not ABA authorization status directly; for PA status use the Provider Express portal or the number on the back of the member's ID card (portal technical support: 1-866-209-9320, same hours).
- **Hours:** Mon-Fri 7:00am-7:00pm CT
- **Portal:** [Provider Express](https://public.providerexpress.com/)

Questions to ask on a verification call:

- Does ABA route through Optum Behavioral Health, or directly through UnitedHealthcare medical benefits for this plan?
- What place-of-service settings are allowed for ABA billing — home, clinic, school, telehealth?
- Is telehealth allowed for any of the ABA codes, and if so which ones?
- Do the published daily unit caps apply to this specific plan, or are they plan-dependent?
- Which credential-tier modifiers (HN/HM/HO/HP) does this plan require, and do they match the standard national tiers?

### 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://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaSCC.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)
- 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/guidelines/reimbPolicies/abaReimburs2020s.pdf (accessed 2026-07-23)
- https://public.providerexpress.com/content/ope-provexpr/us/en/contact-us.html (accessed 2026-07-23)

## Common questions

### Does UnitedHealthcare cover ABA therapy in Utah?

Yes — under Optum's national two-step authorization process for ASD, layered on Utah's mandate (Utah Code § 31A-22-642) for individual and large-group fully-insured plans. Small-group and self-funded employer plans sit outside the mandate, so always verify market segment and funding type first.

### Does Optum have Utah-specific ABA criteria?

No — Utah has no entry in Optum's ABA State Mandates supplemental criteria (January 2026 edition), so Utah commercial ABA runs on Optum's standard national criteria plus the state mandate.

### What does the Utah autism mandate require?

For individual and large-group plans entered or renewed since 1/1/2020: coverage for ASD diagnosis and treatment with no age limit and no cap on ABA hours, a treatment plan due within 14 business days of starting treatment, insurer reviews at most every 3 months, and networks that include BCBAs. Small group is not covered by the statute.

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

Commercial ABA rates are not published — they are negotiated in your participating-provider agreement. Benchmark against Utah Medicaid's published PRISM rates ($19.67/unit on 97153, $37.51 on 97151/97155/97156, effective 7/1/2026) 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 (no Utah entry)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf)
3. [Utah Code § 31A-22-642 (current, eff. 5/6/2026)](https://le.utah.gov/xcode/Title31A/Chapter22/C31A-22-S642_2026050620260506.pdf)
4. [Behavior Analyst Licensing Act — Utah Code 58-61 Part 7](https://le.utah.gov/xcode/Title58/Chapter61/C58-61-P7_2015051220150701.pdf)
5. [Utah Medicaid Managed Care page (PMHP list)](https://medicaid.utah.gov/managed-care/)
6. [Utah Code § 31A-22-642 (prior version, effective 5/4/2022)](https://le.utah.gov/xcode/Title31A/Chapter22/C31A-22-S642_2022050420220504.pdf)
7. [2026 UnitedHealthcare Care Provider Administrative Guide (Commercial), Ch. 7 and Ch. 10](https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/2026-UHC-Administrative-Guide.pdf)
8. [Optum Autism/ABA FAQ (BH3632, October 2021)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaFAQ.pdf)
9. [Utah Admin. Code R590-261-4 — Adverse Benefit Determination Procedure Compliance (Cornell LII mirror; rules.utah.gov blocked)](https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R590-261-4)
10. [29 CFR 2560.503-1(f)(2) — Group health plan claim decision timeframes (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
11. [Utah Code 31A-22-650 — Health care preauthorization requirements (version effective 1/1/2027, SB 319 of 2026)](https://le.utah.gov/xcode/Title31A/Chapter22/C31A-22-S650_2026050620270101.html)
12. [Optum National Network Manual (effective Sept. 1, 2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/adminResourcesMain/netwmanual/NNManual.pdf)
13. [Utah Admin. Code R590-131-6 — Determining Order of Benefits (Cornell LII mirror)](https://www.law.cornell.edu/regulations/utah/Utah-Admin-Code-R590-131-6)
14. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
15. [32 CFR 199.8 — TRICARE double coverage (eCFR)](https://www.ecfr.gov/current/title-32/subtitle-A/chapter-VII/subchapter-M/part-199/section-199.8)
16. [38 CFR 17.276(d) — CHAMPVA last payer to other health insurance (eCFR)](https://www.ecfr.gov/current/title-38/section-17.276)

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.