Advanced Health is the OHP CCO for Coos and Curry counties. It publishes no ABA-specific policy, but its Behavioral Health Authorization Request form (rev. 10/25) names ABA as a request type, and its 2026–2027 provider manual sets the authorization and claims rules.
Advanced Health’s Behavioral Health Authorization Request asks providers to "Mark one" of Hospital Inpatient, Residential, ABA or Out of Network OP visit, and to fax it to Medical Management at 541-269-7147 with a behavioral health treatment plan, assessment and supporting documentation; the instructions add that "In-network providers do not require prior authorization for outpatient visits." The provider manual (2026–2027, rev. 3.2026) says Advanced Health processes standard authorization requests "no later than 7 calendar days following receipt of the request," extendable by up to 14 days, and that "An authorization may be required if Advanced Health is secondary to primary health coverage," with Advanced Health as "a payer of last resort unless the Member also has Indian Health coverage."[1][2][3]
Claims must reach Advanced Health "within 120 days from the date of service," or within 365 days for pregnancy, retroactive eligibility, secondary/tertiary claims and other approved delays.[1][2][3]
OAR 410-141-3565 adds two rules every CCO must follow: a timely claim that needs correction or resubmission gets "a minimum of 180 days after the initial adjudication date," and the CCO "shall pay or deny at least 90 percent of valid claims within 30 days of receipt and at least 99 percent of valid claims within 90 days of receipt." No weekly payment cycle or submission cutoff is published.[1][2][3]
The questions that decide whether a family can start with Advanced Health, and what they have to bring. Each maps onto something intake should ask on the first call.
Advanced Health publishes no age limit. OHP rules require ABA beyond Guideline Note 75 when medically appropriate "including individuals age 13 and older," and under 21 EPSDT bars age-group-wide denials.[3][7][15]
Advanced Health publishes no recency rule. The OHP rule dates only the physical exam and hearing test (OAR 410-172-0770(1)(h)–(i)).[3][7]
Advanced Health publishes nothing different, so the OHP rule applies: a physician, psychologist, or developmental-medicine NP or PA experienced in autism (OAR 410-172-0770(1), 0760(1)).[3][7][6]
Advanced Health publishes nothing different, so the OHP rule applies: a standardized, validated tool such as the ADOS plus developmental status such as the Vineland (OAR 410-172-0770(1)(b), (g)).[3][7]
Advanced Health adds no ABA referral rule of its own, so the OHP rule applies. Yes. Before services, OAR 410-172-0770(1)(k) requires "A referral for ABA treatment with or without specification of hours or intensity" that includes the diagnosis and a copy of the evaluation, from a physician, psychologist, or nurse practitioner or physician associate specializing in developmental medicine who has experience diagnosing and treating autism (OAR 410-172-0760(1)).[3][7][6]
Advanced Health publishes no ABA telehealth rule of its own. The state rule applies: "For purposes of behavioral health services, the Authority shall provide coverage for telemedicine services to the same extent that the services would be covered if they were provided in person" (OAR 410-172-0850(5)), using synchronous two-way video (telephone and e-mail only where HERC guidelines allow). OHA’s behavioral health fee schedule lists modifier GT ("Via Interactive Simultaneous Audio and Video Telecommunication Systems") as an allowable modifier on every ABA code it prices, 97151 through 97157, including the 97151 assessment and 97155 protocol modification.[3][9][10]
Standard authorization requests "no later than 7 calendar days following receipt of the request," extendable by up to 14 additional days when more information is needed or on request.[3][11]
Advanced Health is "a payer of last resort unless the Member also has Indian Health coverage," may still require an authorization when it is secondary, and needs no PA when Medicare is primary and covers the service. Secondary claims may be filed within 365 days.[3][14]
Coverage decides whether Advanced Health pays. These decide whether the claim survives: how sessions must be staffed and supervised, what may be billed concurrently, the per-day ceilings, who signs the note, where the service is payable, and whose NPI the claim goes out under.
Advanced Health publishes no ABA supervision rule, so the state rule applies. OHA does not pay assistant behavior analysts or registered behavior analysis interventionists directly (OAR 410-172-0760(4)); they work under a directly payable Licensed Behavior Analyst, licensed health care professional or declarant. The licensing rule sets the interventionist supervision floor: direct and indirect supervision "for at least 5 percent of the interventionist’s service hours," including direct supervision at least once per calendar month, by a licensed behavior analyst, licensed assistant behavior analyst or licensed health care professional (OAR 824-040-0010). Direct supervision may be remote if it is synchronous audio and video (OAR 824-010-0005).[3][6][13]
Advanced Health publishes no ABA session-note rule. The OHP floor applies: each note "signed or initialed by the individual providing the service" (OAR 410-172-0620(4)).[3][8]
Advanced Health publishes no ABA rendering-provider rule; its form asks for the performing provider and NPI. The OHP rule applies: only a Licensed Behavior Analyst, licensed health care professional or declarant is eligible for direct payment (OAR 410-172-0760(3)–(4)).[2][6]
Not addressed in Advanced Health’s provider manual or BH authorization form.[3][2]
Ask the plan: Advanced Health provider services (providerservices@advancedhealth.com) or your participation agreement.
Advanced Health publishes no ABA unit or hour limit.[3]
Ask the plan: Advanced Health Medical Management, 541-269-7400: ask how ABA units are authorized.
Advanced Health publishes no ABA setting rule.[3]
Ask the plan: Advanced Health provider services: ask which settings and place-of-service codes it pays for ABA.
Yes, under OHP rules. ABA requests go on its Behavioral Health Authorization Request, faxed to Medical Management at 541-269-7147.
120 days from the date of service, or 365 days for exceptions such as secondary claims and retroactive eligibility.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed October 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.
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