AmeriHealth Caritas Louisiana is one of the Healthy Louisiana plans that remain after the 2026 exits. Its ABA clinical policy, CCP.4040, is the LDH manual chapter almost word for word, and its September 2026 provider manual adds the operational detail: how fast it decides, how long you have to file, and how disputes work.
CCP.4040 covers ABA that is medically necessary, prior authorized by the plan, and delivered under the member’s behavior treatment plan, provided by or under the supervision of a Louisiana-licensed behavior analyst, licensed psychologist or medical psychologist, who bills for the services. It lists the same qualified health care professionals and CDE contents as the LDH manual, requires prior authorization of the behavior identification assessment and supporting assessments, limits authorizations to 180 days, and sets the 2:10 supervision ratio. In November 2025 the plan posted its ABA authorization form (the uniform form used by all the plans) under Provider Resources, Forms, and recommends NaviNet for submissions.[1][3][4]
The September 2026 provider manual sets the clocks. Non-urgent prior authorizations: 80% "Within two (2) business days of receiving appropriate documentation," and "All standard Service Authorization shall be made no later than seven (7) Calendar Days following receipt of the request," extendable by up to 14 days; expedited requests within 72 hours. Claims, including those with a primary carrier’s EOB, are due within 365 calendar days of service; corrected or resubmitted claims within 180 days of the denial; retro-enrolled members allow 365 days from service or 180 days from the linkage date, whichever is later. The plan states it processes 90% of clean claims within 15 calendar days and all within 30. Claim disputes start with an independent review reconsideration within 180 days of the remittance advice (resolved within 45 days), then LDH independent review within 60 days. Members may appeal a denial within 60 calendar days of the notice.[2]
The questions that decide whether a family can start with AmeriHealth Caritas Louisiana, and what they have to bring. Each maps onto something intake should ask on the first call.
The plan publishes no recency rule, so the state’s applies. No expiry. "MCOs shall not deny services based solely on the age of the CDE," and "The CDE only needs to be included in the first PA request per member per provider." The MCO "shall deny service if no CDE exists," and if it asks for a new CDE it "shall not deny or delay available ABA services while waiting for a CDE." A family that switches ABA providers needs the CDE sent again with the new provider’s first request.[1][5]
CCP.4040 lists pediatric neurologists, developmental pediatricians, psychologists (including medical psychologists), psychiatrists, team-based pediatricians, nurse practitioners supervised by those specialists, and licensed SLPs, LCSWs or LPCs approved by the plan’s medical director whose scope includes ASD differential diagnosis and who have two years’ experience or work under a QHCP who signs the CDE.[1]
CCP.4040 names no required instrument. The CDE needs history, direct observation, record review, a DSM-5 diagnosis and an ABA rationale; autism-specific, psychopathology, cognitive and adaptive assessments are added only when results are borderline or unclear.[1]
The plan publishes nothing different from the state. Yes: a prescription for ABA "ordered by a QHCP," but "If there is a recommendation in the comprehensive diagnostic evaluation (CDE) for ABA therapy, a separate prescription is not needed." The behavior treatment plan must name the child’s PCP, be sent to the PCP, and progress notes go to the PCP every six months with each renewal. The chapter sets no expiry date for the prescription and does not say the prescriber must appear on the claim; ask the MCO.[1][5]
Yes, with prior authorization. The manual lists 97151–97158 as telehealth-eligible; services must be "rendered or directed by an RLT, LBA, or CaBA" over interactive audio/video, and reassessments can be remote only if the same standard of care can be met. It points to the Claim Filing Instructions for billing (POS and modifier not stated in the manual).[2]
Non-urgent: 80% within 2 business days of receiving the documentation, all within 7 calendar days of the request (extendable up to 14 days); expedited within 72 hours. That matches the federal 7-day cap for rating periods from January 1, 2026.[2][7]
The manual says the plan is "the “payer of last resort” on all claims submitted," and claims with the primary carrier’s EOB must still arrive within 365 days of the date of service. Medicaid pays last (42 CFR 433.139). The LDH manual lets the MCO "bypass the prior authorization (PA) process and acknowledge the PA granted by the primary insurer" when another insurer covers ABA. The MCOs tightened this in November 2025: with the new uniform ABA form, if the primary insurance covers ABA, "Medicaid will remain the payor of last resort, and the authorization will be placed in a pending status until primary coverage is confirmed," so send the primary insurer’s approval or denial with the Medicaid request.[2][8][5][4]
Coverage decides whether AmeriHealth Caritas Louisiana 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.
CCP.4040 adopts the state ratio: supervision "shall be approved on a 2:10 basis," part of it in the presence of the member and the CaBA or RLT, not approved when the supervisor is delivering direct therapy, and no more than 24 technicians a day or 10 CaBAs per licensed professional.[1]
Yes. CCP.4040: "One on one supervision may by be conducted and billed simultaneously and concurrently with one-on-one therapeutic behavioral services. Supervision can only occur when a non-licensed professional is providing the therapeutic behavioral services."[1]
CCP.4040 and the manual add no note rule of their own, so the LDH manual applies. Start and stop times are required "for every code billed" (at the start of the session, after any break of 12 minutes or more, and on a switch of billing code). "The person delivering the service must sign, date, and include their credentials in the documentation for each day and distinct session," and the daily log must also carry the "Name, signature, and credentials for supervising BCBA who is also rendering provider for billing." For an RLT session, recorded data can replace the narrative. Records are kept at least six years.[1][5]
CCP.4040 requires the treatment plan to name the location (home, clinic, school, camp) and an addendum if it changes; the LDH manual otherwise governs. Services "must be provided in a natural setting (e.g., home and community-based settings, including clinics and school)," and school-based ABA by ABA providers is allowed. A treatment plan that puts services in a school "will not be approved until an IEP is provided" to the MCO. Sessions at a "non-ABA facility" (any place other than the home that does not offer ABA as a primary service) need an addendum explaining why they cannot happen at home or at the ABA facility. A change of setting mid-authorization needs a treatment-plan addendum. Overlap with other therapies (speech, OT, PT, waiver services): ABA may be delivered "simultaneously with another service, if allowed per medically unlikely edits and coding guidelines," only when "the other service in question must not have a restriction that keeps it from being performed at the same time as another service," and the treatment-plan addendum must give the frequency and duration of sessions when the ABA provider and the other provider are both present and what the other provider needs to implement the skill.[1][5]
"Payment for services must be billed by the licensed professional" (CCP.4040). The LDH manual adds that the rendering provider on the claim must be the supervisor who signed the documentation. The plan’s ABA billing specifics sit in its Claim Filing Instructions, which we did not read.[1][5][2]
Neither CCP.4040 nor the provider manual publishes an ABA unit cap; hours come from the authorized weekly schedule, and authorizations run no more than 180 days.[1][2]
Ask the plan: AmeriHealth Caritas Louisiana BH utilization management or Provider Services, 1-888-922-0007: ask how ABA units are authorized and edited.
Yes, for members ages 0–20 with a comprehensive diagnostic evaluation from a qualified health care professional, under clinical policy CCP.4040.
Its September 2026 manual says 80% of non-urgent requests within 2 business days of receiving documentation and all within 7 calendar days of the request; expedited requests within 72 hours.
365 calendar days from the date of service, 180 days to resubmit a denied claim, and later deadlines for retroactively enrolled members.
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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