---
title: "AmeriHealth Caritas New Hampshire ABA coverage: the intake guide."
url: "https://carelu.com/payers/amerihealth-caritas-new-hampshire"
markdown_url: "https://carelu.com/payers/amerihealth-caritas-new-hampshire.md"
state: NH (New Hampshire)
payer: AmeriHealth Caritas New Hampshire
kind: Medicaid managed care plan (MCO)
parent_program: New Hampshire Medicaid (Medicaid Care Management)
description: "How AmeriHealth Caritas New Hampshire covers ABA for NH Medicaid members: EPSDT coverage under 21, where the prior-authorization rules actually live, credentialing timelines, turnaround, and what intake should collect."
last_reviewed: September 2026
---

# AmeriHealth Caritas New Hampshire ABA coverage: the intake guide.

_Payer Guide · AmeriHealth Caritas · New Hampshire · Last updated September 2026 · 7 primary sources_

> NH Medicaid MCO that lists ABA under EPSDT; PA rules sit in a lookup tool, and its manual still prints a 14-day clock.

AmeriHealth Caritas New Hampshire is one of the three Medicaid Care Management plans DHHS lists. Its June 2026 provider manual names "Early and Periodic Screening, Diagnostic and Treatment Services including Applied Behavioral Analysis Coverage" as a covered service, so ABA for its members goes through the plan, not the state. What the manual does not do is spell out ABA’s prior-authorization rules; those sit in the plan’s online lookup tool.

This plan administers the **New Hampshire Medicaid (Medicaid Care Management)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [New Hampshire Medicaid guide](https://carelu.com/payers/new-hampshire-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment:** Not published / unverified. Verify via: AmeriHealth Caritas NH Prior Authorization Lookup Tool (amerihealthcaritasnh.com → Provider → Prior Authorization) or the UM line, 1-833-472-2264: check 97151 and 97152. [1][2]
- **Prior auth for treatment:** Not published / unverified. Verify via: AmeriHealth Caritas NH Prior Authorization Lookup Tool or UM, 1-833-472-2264 (fax 1-833-469-2264): check 97153–97158, 0362T and 0373T. [1][2]
- **Autism diagnosis required?**: Yes. The plan covers ABA as part of NH Medicaid’s EPSDT benefit and publishes nothing different, so the state rule applies: ABA "for individuals with" autism spectrum disorder or pervasive developmental disability (He-W 589.04(ag)) [1][4]

## At a glance

- **Covers ABA?:** Yes, as part of EPSDT for members under 21
- **Prior auth:** Not listed in the manual; check codes in the online lookup tool
- **Submit via:** NaviNet (Medical Authorizations) or UM 1-833-472-2264
- **Decision clock:** Manual prints 14 calendar days; federal rule is 7 for rating periods from 1/1/2026
- **Credentialing:** Decision within 30 calendar days for mental health providers (eff. 1/1/2026)
- **Licensure:** None in NH; BACB certification governs

## Coverage and prior authorization

The manual’s covered-services list includes EPSDT "including Applied Behavioral Analysis Coverage," and for members under 21 it defines medical necessity by the EPSDT standard: any service in section 1905(a) of the Social Security Act "regardless of whether such service is covered under the Medicaid state plan, if that service is necessary to correct or ameliorate" a condition. The manual’s list of services requiring prior authorization names psychological and neuropsychological testing, partial hospitalization and intensive outpatient, but does not name ABA, and it points to the online Prior Authorization Lookup Tool for "the most up-to-date list." Treat the lookup tool as the source for each ABA code rather than reading the manual’s silence as "no PA." Requests go through NaviNet’s Medical Authorizations workflow, by phone to 1-833-472-2264, or by fax to 1-833-469-2264; non-participating providers need prior authorization for everything. [1][2]

## Credentialing and network entry

AmeriHealth Caritas New Hampshire says applicants will be notified of the credentialing decision "within 30 calendar days for PCPs and mental health providers (eff. January 1, 2026), and within 45 calendar days for specialty providers, of receipt of a clean and complete application," and new contracts receive a welcome letter within 30 business days of execution. For new members already in treatment, the plan covers a condition "currently being treated or a prior authorization has been issued for 60 calendar days after the member’s effective date," which protects a family that switches into the plan mid-course. New Hampshire does not license behavior analysts, so expect credentialing to rest on BACB certification. [1][7]

## Intake gates

The questions that decide whether a family can start with AmeriHealth Caritas New Hampshire, and what they have to bring.

- **Age limit**: Under 21. The plan covers ABA within EPSDT, which covers members under 21 (He-W 546.02). [1][4]
- **Referral required?**: The plan publishes nothing different from the state, where ABA must be "recommended by a licensed clinician who has experience in the diagnosis and treatment of autism spectrum disorder" (physician, psychologist, or developmental-medicine NP or PA; He-W 589.04(aj)). [1][4]
- **Other insurance (who pays first)**: "Medicaid HMOs, such as AmeriHealth Caritas New Hampshire, are always the payer of last resort." Bill the primary insurer first and submit its EOB "within 60 days of the date on the primary insurer’s EOB." The exception is preventive pediatric services (including EPSDT), which may be billed to the plan first while it pursues the other payer; the manual does not say whether it treats ABA as preventive. [1][6]
- **Prior-auth decision time** _(plan-dependent)_: The June 2026 manual still says standard decisions are due "no later than 14 calendar days after AmeriHealth Caritas New Hampshire receives the request" (plus up to 14 more), expedited within 72 hours, and urgent extensions of an ongoing course within 24 hours if asked at least 24 hours before it ends. Federal law has since tightened the standard limit: for rating periods starting on or after January 1, 2026, it "may not exceed 7 calendar days." The manual also says decisions not made on time "constitute a denial" that can be appealed. [1][5]
  - Ask the plan: AmeriHealth Caritas NH UM, 1-833-472-2264: confirm whether the 7-day federal standard applies to your request’s rating period.
- **Diagnosis recency** _(ask the plan)_: Not stated by the plan or the state. [1]
  - Ask the plan: AmeriHealth Caritas NH UM, 1-833-472-2264: ask how recent the diagnostic evaluation must be for an initial ABA request.
- **Diagnostic tools required** _(ask the plan)_: Not stated by the plan or the state. [1]
  - Ask the plan: AmeriHealth Caritas NH UM, 1-833-472-2264: ask which instruments it expects with the initial request.
- **Telehealth** _(ask the plan)_: The manual publishes no ABA telehealth rule. [1]
  - Ask the plan: AmeriHealth Caritas NH Provider Services, 1-888-599-1479: ask which ABA codes are payable by telehealth and with which POS code.

## Delivery and billing rules

Coverage decides whether AmeriHealth Caritas New Hampshire 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**: The plan publishes no ABA supervision rule of its own. The state rule applies: He-W 589.04(ah) requires a BCBA with a BACB supervisory certification when supervising, and lets a BCaBA, RBT or rehabilitation assistant deliver ABA under that BCBA’s "appropriate supervision," with no numeric ratio. [1][4]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed in the provider manual, and the state publishes no rule either. [1]
  - Ask the plan: AmeriHealth Caritas NH Provider Services, 1-888-599-1479, or your provider agreement.
- **Daily limits / MUEs** _(ask the plan)_: The manual publishes no ABA unit or hour limit. [1]
  - Ask the plan: AmeriHealth Caritas NH UM, 1-833-472-2264: ask how ABA units are authorized and whether NH Medicaid’s fee-schedule unit maximums apply.
- **Session-note signature** _(ask the plan)_: The manual publishes no ABA session-note signature rule. [1]
  - Ask the plan: AmeriHealth Caritas NH Provider Services, 1-888-599-1479, or the documentation standards in your provider agreement.
- **Place of service** _(ask the plan)_: The manual publishes no ABA setting rule. At the state level, school-based ABA is billed by school districts under the Medicaid to Schools program (He-W 589). [1][4]
  - Ask the plan: AmeriHealth Caritas NH Provider Services, 1-888-599-1479: ask which place-of-service codes it pays for ABA.
- **Bill as provider** _(ask the plan)_: The manual publishes no ABA-specific rendering or supervising-provider billing rule. [1]
  - Ask the plan: AmeriHealth Caritas NH Provider Network Account Executive: ask whether RBTs are billed under the supervising BCBA’s NPI.

## What intake should collect for AmeriHealth Caritas New Hampshire

- **Member ID:** Confirm AmeriHealth Caritas NH (not FFS or another plan) on the date of service.
- **Diagnosis:** Autism spectrum disorder or PDD, the state’s covered ABA diagnoses.
- **Other insurance:** The plan is payer of last resort; bill the primary first and attach its EOB within 60 days.
- **Current authorizations:** New members get 60 days of continuity for ongoing treatment; capture any prior plan’s authorization.

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

## Common questions

### Does AmeriHealth Caritas New Hampshire cover ABA?

Yes. Its provider manual lists EPSDT "including Applied Behavioral Analysis Coverage" for members under 21.

### Does AmeriHealth Caritas NH require prior authorization for ABA?

The manual’s PA list doesn’t name ABA and points to the online lookup tool for the current list. Check each ABA code there before starting services.

### How long does credentialing take?

The plan says it notifies mental health providers of the decision within 30 calendar days of a clean and complete application (effective January 1, 2026).

## Primary sources

1. [AmeriHealth Caritas New Hampshire — Provider Manual (published June 2026)](https://www.amerihealthcaritasnh.com/content/dam/amerihealth-caritas/acnh/pdf/provider/provider-manual.pdf.coredownload.inline.pdf)
2. [AmeriHealth Caritas New Hampshire — Prior Authorization lookup tool](https://www.amerihealthcaritasnh.com/provider/resources/prior-auth)
3. [NH DHHS — Medicaid Care Management (the three Medicaid health plans)](https://www.dhhs.nh.gov/programs-services/medicaid/medicaid-care-management)
4. [N.H. Admin. Rules He-W 500 — Medical Assistance (He-W 506, 530, 546 EPSDT, 589 Medicaid to Schools)](https://www.gencourt.state.nh.us/rules/state_agencies/he-w500.html)
5. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
6. [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)
7. [BACB — U.S. Licensure of Behavior Analysts (New Hampshire not listed)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)

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.