In New Hampshire, Anthem Blue Cross and Blue Shield is Anthem Health Plans of New Hampshire, Inc., with HMO plans underwritten by Matthew Thornton Health Plan, Inc. Two Anthem documents govern ABA here: the New Hampshire precertification list, which puts every ABA code under Anthem’s own behavioral health review, and the multi-state ABA Provider Resource Guide, which names New Hampshire among its states and sets the coding, supervision and documentation rules.
Under both sits New Hampshire’s autism mandate for fully insured plans. Establish funding type on every benefits check: self-funded employer plans administered by Anthem answer to their own plan documents and ERISA, not RSA 417-E.
Anthem’s New Hampshire Precertification/Prior Authorization List (updated October 15, 2026) lists 97151, 97152, 97153, 97154, 97155, 97156, 97157, 97158, 0362T and 0373T. For each, the reviewer is "Anthem" (not Carelon, which handles therapy and imaging on the same list), the criteria are "MCG Guidelines," and the instruction is "Contact Behavioral Health at 800-755-0851," with the caveat that requirements "vary by product and plan. Contact the number on the member’s ID card to verify requirements and eligibility." On HMO plans the rendering provider must request precertification; on PPO plans the network provider is responsible, while a BlueCard or non-participating provider leaves that to the member.[2]
Anthem’s ABA Provider Resource Guide (June 2025) covers New Hampshire. Approved providers include psychiatrists, psychologists, LCSWs, LPCs and LMFTs with ABA training, BCBAs and BCBA-Ds, "providers practicing under the direction and supervision of the BCBA," and other state-recognized mental health providers. A QHP billing 97155 "can only add code 97153 if both the technician and QHP are face-to-face with the patient at the same time and the QHP is directing the technician." Technician services "must show the supervising BCBA or other QHP in box 31." Record start and stop times, sign within 30 days of the date of service, and update the treatment plan at least every 6 months. Anthem applies NCCI medically unlikely edits to ABA codes and lists POS 12 (home), 11 (office), 99 (community), 03 (school), and 10 and 02 (telehealth).[3]
New Hampshire’s autism mandate sits inside its mental-illness parity statute. RSA 417-E:1 requires every insurer, nonprofit health service corporation and HMO issuing or renewing accident or health coverage in the state to cover "pervasive developmental disorder or autism" on terms "no less extensive than the coverage provided for any other type of health care for physical illness." RSA 417-E:2 then defines the treatment: "applied behavioral analysis, necessary to produce socially significant improvements in human behavior or to prevent loss of attained skill or function," plus pharmaceuticals, psychiatric, APRN, psychologist and social-work services, and speech, occupational and physical therapy. Two conditions bind ABA specifically. It "must be provided by a person professionally certified by the national Behavior Analyst Certification Board or performed under the supervision of" one. And the insurer "may require submission of a treatment plan, including the frequency and duration of treatment," signed by the primary care provider or a listed specialist (child psychiatrist, developmental-behavioral pediatrician, child neurologist, or a psychologist trained in child psychology), updated "no more frequently than on a semi-annual basis." Coverage "shall not be denied on the basis that services are habilitative in nature." The age and dollar question has changed since enactment: HB 569 as passed in 2010 let a policy "limit coverage for applied behavior analysis to $36,000 per year for children 0 to 12 years of age, and $27,000 from ages 13 to 21." That paragraph does not appear in the current RSA 417-E:2, whose source note lists amendments in 2011 and 2022, and no other age or dollar limit appears in the section. Autism Speaks’ New Hampshire summary (last updated December 2019) still describes the caps, so expect some plan documents and benefit summaries to lag. The mandate reaches fully insured plans only; self-funded employer plans answer to ERISA and federal parity.[4][5]
New Hampshire does not license behavior analysts. The BACB’s state licensure table (updated 2026) lists no New Hampshire law or board, and the practical credential is therefore BACB certification, which the mandate itself requires. That shapes credentialing in two ways. First, carriers credential BCBAs on certification rather than a state license number, even where a form asks for one (WellSense’s New Hampshire ABA form has a "BCBA license #" field). Second, the state credentialing clock in RSA 420-J:4 does help: a carrier must tell you an application is incomplete within 15 business days and must "act upon and finalize the credentialing process within 30 calendar days" of a clean and complete application for primary care physicians and mental health providers (45 days for specialists). The statute does not say which bucket a BCBA falls in, so ask. The provisional-pay rule in RSA 420-J:8-c is keyed to "a valid license from the respective state licensing board," which New Hampshire BCBAs do not hold, so do not plan on being paid before credentialing completes. On rates: commercial ABA rates are negotiated and unpublished. RSA 417-E:1, V-b requires carriers’ contracts to pay mental health and substance use treatment services, on average, at least as favorably as non-hospital primary care, measured against relative Medicare reimbursement; the statute does not say whether ABA codes are in that comparison. The public benchmark is the NH Medicaid fee-for-service schedule, which is low (97153 $17.79 and 97155 $16.43 per 15-minute unit).[8][6][4][10][14]
New Hampshire’s RSA 420-J:8-a makes health carriers pay clean claims for services rendered in New Hampshire "within 30 calendar days upon receipt of a clean non-electronic claim or 15 calendar days upon receipt of a clean electronic claim," with 1.5% interest per month on overdue claims. A carrier is not in violation for a claim submitted more than 90 days after the service.[13][1][3]
Anthem’s New Hampshire commercial provider manual (effective July 1, 2026) leaves the initial filing limit to the contract: claims “must be submitted within the timely filing timeframe specified in the Provider or Facility Agreement.” Adjustments and corrected claims are due “no later than twelve (12) months from the date of payment or explanation of payment,” sent electronically with frequency code 7 (replacement) or 8 (void) and the original claim number. Claims must carry “complete provider information, including referring, rendering, and billing NPI.” Payment disputes run in two steps: a Claim Payment Reconsideration within 365 days of the EOP issue date, then a Claim Payment Appeal “within ninety (90) days from the date of the determination” of the reconsideration. The manual says nothing about taxonomy codes or electronic visit verification.[13][1][3]
Codes: Anthem’s ABA Provider Resource Guide lists CPT 97151–97158 and Category III codes 0362T and 0373T, with credential modifiers HM (less than bachelor’s), HN (bachelor’s) and HO (master’s), and no HCPCS H-code such as H0031 or H0032. Its place-of-service list gives 12 home, 11 office/clinic, 99 community, 03 school, 10 telehealth with the member at home and 02 telehealth elsewhere, subject to the member’s coverage; allowed telehealth codes come from Anthem’s Virtual Visits reimbursement policy.[13][1][3]
A child whose card comes from another state’s Blue plan is a BlueCard member, and Anthem is the local plan. Anthem’s New Hampshire provider manual says that "If the Member’s home plan is not with Anthem, the applicable home plan will determine prior authorization requirements". Anthem’s prefix lookup tool identifies the home plan from the three-character prefix on the ID card. For medical policy and prior authorization rules, use Resources > Prior Authorization > "Medical Policy and Prior Authorization for Blue Plans" and enter the prefix. So an out-of-state child’s ABA assessment and treatment are authorized under the home plan’s ABA policy, not Anthem’s.[1]
On utilization-management appeals the manual says decisions "involving Pre-certification/Pre-authorization are the responsibility of the Blue Plan, insuring or administering benefits for non-Anthem Members (the Member’s Home Plan)". It also says that "Technically, the Member, not the Provider or Facility, is responsible for obtaining the necessary authorization prior to the delivery of non-inpatient admission services". In practice the ABA provider requests it on the family’s behalf. A claim-denial appeal goes to the local Anthem plan as a Claim Payment Dispute.[1]
Only with an approved out-of-network referral where the plan requires referrals. Anthem's 2026 New Hampshire manual says referrals to providers “who do not participate in the Anthem Provider network (out-of-network Providers) require the PCP to submit an out-of-network referral request to Anthem,” and “authorization must be received before the out-of-network Provider Services can be rendered.” Requests go by fax to 800-281-1049 or phone to 800-531-4450. Whether the member has out-of-network ABA benefits depends on the plan.[1]
The questions that decide whether a family can start with Anthem Blue Cross and Blue Shield New Hampshire, and what they have to bring. Each maps onto something intake should ask on the first call.
Anthem’s NH documents require precertification from the rendering provider (HMO) or network provider (PPO), not a physician referral. On the claim, Anthem’s 2026 New Hampshire manual says that after treating a member who self-referred instead of getting a PCP referral, “include the word SELF in Box 17 (Name of Referring Provider or Other Source) of the CMS-1500 claim form.” PCPs need not notify Anthem of in-network referrals, except New England Health Plan “cross-border” referrals to a provider outside New Hampshire. For a fully insured New Hampshire plan, RSA 417-E:2, II lets the insurer require a treatment plan, with frequency and duration, signed by the primary care provider or a listed specialist, updated no more than every six months. Self-funded ERISA plans sit outside the statute.[2][1][4]
Anthem publishes no ABA age limit in its New Hampshire documents. For fully insured New Hampshire plans, the current RSA 417-E:2 carries no age or dollar limit on ABA (the 2010 caps of $36,000 a year for ages 0–12 and $27,000 for 13–21 are no longer in the text). Self-funded ERISA plans are outside the statute, so plan funding type decides whether that binds.[2][4][5]
Ask the plan: Live benefits verification on the member ID: establish fully insured vs. self-funded, then the plan’s own age terms.
Anthem lists POS 10 (telehealth in the member’s home) and 02 (telehealth elsewhere) for ABA, subject to coverage, and refers to its Virtual Visits reimbursement policy, where "Allowed codes may vary." For a fully insured New Hampshire plan, RSA 415-J:3 says an insurer “may not deny coverage on the sole basis that the coverage is provided through telemedicine” and must cover and reimburse it “on the same basis” as in person, with “no restriction on eligible originating or distant sites,” for “all modes of telehealth.” Its list of providers who may use all modes includes “Professionals certified by the national behavior analyst certification board or persons performing services under the supervision of” a BACB certificant “as required by RSA 417-E:2.” Self-funded employer plans are outside the state statute.[3][11]
Ask the plan: Anthem Virtual Visits reimbursement policy and the member’s benefits: confirm which ABA codes are allowed by telehealth.
Depends on how the plan is funded. Fully insured New Hampshire plans fall under RSA 420-J:6. For requests sent through the carrier’s electronic prior-authorization process, a non-urgent decision is due "within 7 calendar days of obtaining all information necessary to make the determination"; for paper or fax requests the limit is 14 calendar days; urgent requests are decided within 72 hours. Any request for more information must come within 7 calendar days of the request date, and information supplied in a peer-to-peer counts. A missed deadline means the request "shall be considered approved." Once approved, the carrier may not revoke or limit it "if care is provided within 60 business days" of the approval, and a peer-to-peer must be offered within 2 business days of a request. Self-funded employer (ERISA) plans follow 29 CFR 2560.503-1 instead: pre-service decisions "not later than 15 days after receipt of the claim," one 15-day extension, urgent care within 72 hours. Anthem publishes no New Hampshire-specific ABA turnaround or reauthorization lead time.[6][9]
Ask the plan: At benefits verification ask whether the plan is fully insured (New Hampshire-regulated) or self-funded (ERISA), whether you are submitting electronically, and what reauthorization lead time Anthem expects.
For a child on two group plans, New Hampshire follows the birthday rule: when parents are married or living together, "the plan of the parent whose birthday falls earlier in the calendar year is the primary plan" (Ins 1904.05(d)(2)); for separated parents a court decree controls, and otherwise the custodial parent’s plan pays first. That rule binds group plans regulated by the state; a self-funded plan sets its own order. When both plans require precertification, RSA 420-J:3-b says the member "shall obtain pre-certification from the primary plan," and the secondary plan "shall not refuse payment for such services solely on the basis that the services were not pre-certified by the secondary plan" (it can still apply its own criteria). If the child also has NH Medicaid, Anthem pays first: Medicaid is payer of last resort (42 CFR 433.139), and NH Medicaid will not pay a balance the primary denied for "incorrect billing, non-eligible provider, or lack of medical necessity." TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270).[7][6][15][16][17][18]
Ask the plan: Ask Anthem at benefits verification for the member’s coordination-of-benefits order (and whether a self-funded plan uses the birthday rule), and record every other coverage the child has.
Not published in Anthem’s NH documents; the review uses MCG guidelines, which are licensed and not public.[2]
In licensed criteria: Anthem Behavioral Health, 800-755-0851: ask what diagnostic documentation and dates MCG review expects.
Not published in Anthem’s NH documents; set by the licensed MCG guideline and the plan. LCSW: no published rule. The plan names no diagnosing-provider list, so ask it whether an LCSW's diagnosis is accepted.[2][3]
In licensed criteria: Anthem Behavioral Health, 800-755-0851.
The resource guide stresses "standardized assessments and current clinical information" for tracking progress but names no diagnostic instrument; the MCG criteria are licensed.[3]
In licensed criteria: Anthem Behavioral Health, 800-755-0851.
Coverage decides whether Anthem Blue Cross and Blue Shield New Hampshire 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.
Anthem publishes no numeric supervision ratio. It recognizes "providers practicing under the direction and supervision of the BCBA," and allows 97153 alongside 97155 only when the QHP and technician are both face-to-face with the patient and the QHP is directing the technician. The NH mandate itself requires ABA to be provided by, or "under the supervision of," a BACB certificant.[3][4]
"A physician or other QHP billing for 97155 can only add code 97153 if both the technician and QHP are face-to-face with the patient at the same time and the QHP is directing the technician." Supervised services billed with a QHP procedure fall under Anthem’s Incident To reimbursement policy.[3]
No Anthem-specific daily cap is published. "ABA codes may have associated MUE limits," and Anthem administers NCCI edits, updated as CMS publishes new medically unlikely edits. Authorized hours are set per precertification.[3]
Each entry must identify its author (signature, electronic identifier or initials, with credentials). Documentation is expected "at the time of service, or shortly thereafter and should not exceed 30 days," with a "Signature date within 30 days of the date of service." Start and stop times are required for timed codes.[3]
POS codes Anthem lists for ABA: 12 home, 11 office/clinic, 99 community, 03 school, 10 telehealth in the home, 02 telehealth outside the home, all "Subject to the member’s coverage and reviews by the plan." RSA 417-E:2 does not change any obligation of a school district to provide IEP services.[3][4]
"ABA therapy performed by therapy assistants/behavioral technicians/paraprofessionals must show the supervising BCBA or other QHP in box 31 of the CMS claim form."[3]
Where the plan uses PCP referrals, the PCP must get an out-of-network referral approved by Anthem (fax 800-281-1049, phone 800-531-4450) before services. Out-of-network ABA benefits depend on the member's plan.
Yes. All ABA codes (97151–97158, 0362T, 0373T) are on Anthem’s New Hampshire precertification list, reviewed by Anthem Behavioral Health (800-755-0851) on MCG criteria, though requirements can vary by product.
Not in the current law. The 2010 statute allowed caps of $36,000 a year (ages 0–12) and $27,000 (13–21), but that paragraph no longer appears in RSA 417-E:2. Self-funded plans follow their own documents.
Yes, 97155 with 97153, but only when both are face-to-face with the patient at the same time and the BCBA is directing the technician.
Fifteen calendar days for a clean electronic claim and 30 for paper (RSA 420-J:8-a), on plans subject to the Managed Care Law. Claims filed more than 90 days after service lose that protection.
The child’s home plan. Anthem’s manual says that when the member’s home plan is not Anthem, "the applicable home plan will determine prior authorization requirements." Look the prefix up under Medical Policy and Prior Authorization for Blue Plans on Anthem’s provider site, request authorization from the home plan, and file the claim with Anthem as the local plan.
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.
Carelu collects all of this automatically.
Every ID, document, and detail this payer requires — gathered conversationally the moment a family reaches out, with insurance verified before your team touches the file.
Get a Demo