This guide is for Anthem Blue Cross and Blue Shield commercial members in Indiana. Anthem also runs Indiana Medicaid plans, which follow IHCP rules and have their own guide (anthem-indiana-medicaid); settle the line of business before anything else.
The question intake teams ask most is whether an Anthem ABA request goes to Carelon Behavioral Health. For Indiana commercial it does not. Anthem's Indiana preapproval list names Anthem as the responsible party for ABA. The only Carelon companies on that list are Carelon Medical Benefits Management and CarelonRx, which handle imaging, specialty programs and pharmacy. When a 2023 Carelon Behavioral Health contract letter reached Indiana providers, Anthem told them it was an Ohio matter sent "in error." What decides whether review happens at all is how the plan is funded.
Anthem's commercial preapproval list, updated January 1, 2026, is shared by Indiana, Kentucky, Missouri, Ohio and Wisconsin. Under behavioral health services it lists "Applied behavioral analysis (ABA)" for "OH, IN, KY Blues products," and the responsible party is Anthem. A separate "Treatment for autism spectrum disorder" row also sits on the list. The Carelon companies named in the document are Carelon Medical Benefits Management ("an independent company providing utilization management services") and CarelonRx (pharmacy). Carelon Behavioral Health does not appear.[12][16][15]
Anthem said so directly to Indiana commercial providers when a Carelon Behavioral Health contract-assignment letter went out in 2023: "If you are not an Ohio contracted provider, please be aware this letter was sent to you in error and may be disregarded." The review criteria are Anthem's too: "Effective June 1, 2024, Anthem will transition from CG-BEH-02 (Adaptive Behavioral Treatment) and MCG W0153 … to MCG B-806-T Behavioral Health Care Applied Behavioral Analysis (Original MCG Guideline), for medical necessity/clinical appropriateness reviews." MCG criteria are licensed and not published. If a denial letter still cites CG-BEH-02, raise that on appeal.[12][16][15]
The preapproval list says it applies "to local fully insured Anthem members and select members who are covered under self-insured (ASO) benefit plans with services medically managed as part of a purchased program," and that "If the program has not been purchased, preapproval is not required, and clinical review will not be performed." It does not apply to BlueCard, Medicare Advantage, Medicaid, Medicare Supplement or FEP. On Anthem National Accounts business the rule is softer: "Precertification for ABA is recommended and applies unless the group specifically opts out of clinical review for this benefit. Retrospective review is allowed."[12][13][17]
Funding also decides whether Indiana's mandate applies. IC 27-8-14.2 regulates insurers' accident and sickness policies. It excludes accident-only, dental, vision, Medicare supplement, long-term care and disability income coverage, specified-disease and indemnity policies, qualifying short-term plans, supplemental plans and student health plans. A self-funded employer plan that Anthem only administers is not an insurance policy, so the plan document and federal parity law govern it instead. Ask the funding question before you tell a family what the law guarantees.[12][13][17]
A group accident and sickness policy "must provide coverage for the treatment of an autism spectrum disorder of an insured," limited "to treatment that is prescribed by the insured's treating physician in accordance with a treatment plan." An insurer issuing individual policies "must offer to provide" the same coverage, so an individual plan may lawfully lack it. Group and individual HMO contracts follow the same pattern under IC 27-13-7-14.7.[19][20][21][18]
The statute sets no age, hour, visit or dollar cap. Its only limit language is parity: coverage "may not be subject to dollar limits, deductibles, or coinsurance provisions that are less favorable to an insured than" those for physical illness generally (the HMO section adds copayments). Insurers also may not refuse, terminate or restrict coverage "solely because the individual is diagnosed with an autism spectrum disorder." The chapter defines autism spectrum disorder as "a neurological condition, including Asperger's syndrome and autism, as defined in the Diagnostic and Statistical Manual of Mental Disorders."[19][20][21][18]
The Indiana Professional Licensing Agency posted on May 13, 2025 that "Licensed Behavior Analyst and Licensed Assistant Behavior Analyst applications are now live." A behavior analyst license requires BCBA certification from the BACB or another approved entity and a national criminal history background check. Since then an individual may not "practice applied behavior analysis" or use the initials LBA or LABA without a license.[24][22][23]
The exceptions matter for staffing. A licensed or certified health care professional may use ABA within their own scope. So may a student or trainee, and a non-resident who works in Indiana no more than 5 days a month and 15 days a year while authorized at home. So may "an applied behavior analysis direct contact technician" or a family member implementing a plan at home, "who acts under the extended authority and direction of a behavior analyst or assistant behavior analyst licensed under this chapter." Technicians therefore work under the supervising analyst's Indiana license, not a state credential of their own.[24][22][23]
Anthem's commercial ABA provider resource guide (June 2025) lists Indiana among its eleven states. It covers billing, coding and documentation, not authorization. Its approved rendering providers include psychiatrists, psychologists, LCSWs, LPCs and LMFTs with ABA training or experience, BCBAs and BCBA-Ds, "providers practicing under the direction and supervision of the BCBA," and other state-licensed providers the plan recognizes. Technician and paraprofessional claims must show the supervising BCBA or other QHP in box 31 of the CMS-1500, with modifiers HM, HN or HO for the rendering staff's degree level.[14]
On concurrent billing, 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." Records need total treatment time plus start and stop times, author identification on every entry, and a signature date within 30 days of service. Treatment plans must show review or update at least every 6 months.[14]
Indiana licenses the practice: an individual may not “practice applied behavior analysis” unless the individual “holds a license issued under this chapter” (IC 25-8.5-3-6(a)); the PLA takes reciprocity applications ($75 for an LBA). Indiana’s telehealth law (IC 25-1-9.5) defines a telehealth “practitioner” as someone holding “an unlimited license to practice” in Indiana and lists “a behavior analyst licensed under IC 25-8.5,” so plan on an Indiana license before treating a child located in Indiana remotely.[25][26][27][14]
Anthem’s ABA Provider Resource Guide (June 2025) lists BCBAs among approved providers, alongside “other mental health service providers licensed or authorized by the state in which they practice and recognized by the affiliated health plan Anthem to be eligible for reimbursement,” and sends providers to the state-specific Credentialing with Anthem pages; for telehealth it points to Anthem’s Virtual Visits reimbursement policy for the allowed codes. It does not say which state’s license a remote BCBA needs, so confirm with Anthem credentialing before treating a member remotely from another state.[25][26][27][14]
Indiana’s prompt-pay statute for insurers, IC 27-8-5.7, requires an insurer to pay or deny each clean claim within thirty days after receipt if it was filed electronically and within forty-five days if filed on paper (§ 6). The insurer must tell the provider of any deficiency within the same thirty or forty-five days and describe how to fix it; if it does not, “the submitted claim” is established “as a clean claim” (§ 5). Interest on a late clean claim starts on day 31 (electronic) or day 46 (paper) and runs until payment. These statutes bind fully insured plans issued in the state; a self-funded employer plan (ERISA) is not subject to them and follows its plan documents and your contract.[28][29][31]
Filing deadline: Anthem’s 2026 Indiana commercial provider manual (effective August 1, 2026) prints no number of days — “Claims must be submitted within the timely filing timeframe specified in the Provider or Facility Agreement,” late claims “will be denied” unless proof of timely filing is shown (a computer-printed filing date, a fax confirmation, a billing-system printout or an accepted clearinghouse report), and “any rejected Claims must be corrected and resubmitted within the timely filing period.” The deadline for original, corrected and secondary claims is therefore the one in your Anthem agreement.[28][29][31]
BlueCard is the program that lets an Anthem Indiana member be treated by a Blue-contracted provider in another state. Anthem's BlueCard Provider Manual defines it as "a national program that enables members of one BCBS Plan to obtain healthcare service benefits while traveling or living in another BCBS Plan's service area." It works through each provider's own local plan: "The program lets you submit claims for patients from other BCBS Plans, domestic and international, to your local BCBS Plan. Your local BCBS Plan is your sole contact for claims payment, adjustments and issue resolution."[30][31][12]
So for a practice contracted with another Blue, such as another state's Blue plan, treating an Anthem Indiana member, the claim goes to your local Blue, not to Anthem. The manual's worked example: "the provider ... files a claim locally," and the local plan "forwards the claim to [the member's plan] that adjudicates the claim according to the member's benefits and the provider's arrangement with" the local plan. Put the member's full ID, including the three-character prefix, on the claim. "Claims with incorrect or missing prefixes and member identification numbers cannot be processed." Network status comes from your contract with your local Blue, matched to the member's product. A PPO member must see a BlueCard PPO provider "if they want to access PPO in-network benefits."[30][31][12]
Prior authorization stays with the home plan, Anthem. Anthem's out-of-area tool (anthem.com, Prior Authorization, "Medical Policy and Prior Authorization for Blue Plans," entered with the member's alpha prefix) shows its general precertification rules. The BlueCard manual gives the routes: Electronic Provider Access through your own local Blue's portal, which forwards you to the home plan's pre-service review tool; a HIPAA 278 transaction; or 1-800-676-BLUE (2583), asking for the utilization review area, which has a Behavioral Health option. ABA is on Anthem's commercial precertification list, so obtain it from Anthem before services start. The manual reminds providers that the member is technically "responsible for obtaining pre-certification/preauthorization for out-patient services from their BCBS Plan," and most practices get it for them. Anthem's Indiana provider manual adds that appeals of pre-certification decisions for BlueCard members are "the responsibility of the Blue Plan, insuring or administering benefits" (the home plan).[30][31][12]
Reauthorization: Anthem’s ABA provider resource guide (June 2025) sets no reauthorization data list and no graph requirement; medical necessity is decided against the clinical criteria named on Anthem’s precertification list for the member’s product, so what a continued-review packet must show — and whether progress must be graphed — is the reviewer’s call. Ask the Anthem behavioral health reviewer at the initial request what data, measures and format the next review will need. What the guide does fix is documentation: every record entry must be complete, dated and signed with credentials, entered at or shortly after the service and not later than 30 days, with the signature dated within 30 days of the date of service.[14]
Code set and supervision: the guide lists the ABA Category I CPT codes 97151–97158 and Category III 0362T and 0373T, and tells providers to bill industry-standard CPT, HCPCS or revenue codes and to check the provider contract for any specific billing requirement — it lists no HCPCS H-code for ABA. Claims carry a licensure modifier (HM, HN or HO) and, for technician-delivered services, the supervising BCBA or other QHP in box 31. A QHP billing 97155 may add 97153 only when both are face to face with the patient and the QHP is directing the technician; no supervision ratio or technician cap is published.[14]
Indiana law sets a short credentialing clock for an “insurer that issues or administers a policy that provides coverage for basic health care services” (IC 27-8-11-7). The insurer must notify the provider of a deficiency on a completed unclean credentialing application “not later than five (5) business days after the entity receives” it, describing the deficiency and why the application is unclean, and the provider has five business days to respond. “If the insurer fails to issue a credentialing determination within fifteen (15) business days after receiving a completed clean credentialing application form from a provider, the insurer shall provisionally credential the provider” under NCQA provisional-credentialing standards; the provisional status lasts “until a determination is made.” Once the provider is fully credentialed under an executed agreement, payment is retroactive to the date of provisional credentialing; an adverse determination ends the provisional status. The form is the CAQH application the Department of Insurance prescribes. Anthem publishes no Indiana ABA-specific credentialing turnaround that we found. Submit each new BCBA’s CAQH profile complete and attested, note the date, and ask about provisional credentialing if 15 business days pass without a decision.[33]
The questions that decide whether a family can start with Anthem Blue Cross and Blue Shield Indiana (commercial), and what they have to bring. Each maps onto something intake should ask on the first call.
None in the statute. IC 27-8-14.2 sets no age, hour, visit or dollar limit on the autism benefit; its only limit language is parity with physical illness for dollar limits, deductibles and coinsurance (copayments too, for HMOs). The fork that matters is group, individual or self-funded, not age.[19][21]
Yes, by statute on insured plans: coverage "is limited to treatment that is prescribed by the insured's treating physician in accordance with a treatment plan" (group policies must cover; individual-policy insurers must offer). Self-funded plans follow their plan document.[19][20]
Anthem lists telehealth POS 10 (member at home) and 02 (member elsewhere) for ABA but no national list of telehealth-eligible ABA codes: "Allowed codes may vary. Refer to the Allowed virtual services in addition to CPT Appendix P to obtain codes that are eligible for reimbursement in your state." A non-resident analyst may practice in Indiana only within the 5-days-a-month, 15-days-a-year exception unless Indiana-licensed. Anthem’s Virtual Visits policy C-08002 (last approval 3/26/2026), which names Indiana, requires audio-video claims to carry POS 02 or 10, modifier 95 or GT and “The appropriate CPT/HCPCS code in CPT Appendix P (or document referenced in the Related Policies and Materials section)”; professional virtual visits are paid at the non-office rate. It names no ABA code.[11][14][23]
Blocked on: Anthem's Virtual Visits reimbursement policy and its Indiana allowed-virtual-services list, or Anthem provider services, before scheduling remote hours.
Depends on funding. A fully insured Indiana policy or HMO is a "health plan" under IC 27-1-37.5-5, so IC 27-1-37.5-23 applies: urgent requests answered "not later than twenty-four (24) hours," all others "not later than forty-eight (48) hours," excluding weekends and state and federal holidays; a missed deadline means the service "shall be automatically deemed authorized" (IC 27-1-37.5-28). A self-funded ERISA plan follows 29 CFR 2560.503-1: urgent "not later than 72 hours after receipt of the claim," pre-service within a reasonable time "but not later than 15 days after receipt of the claim," and an urgent request to extend ongoing treatment made "at least 24 hours prior to the expiration" is decided within 24 hours. ASO groups without Anthem's medical-management program have no preapproval, so no clock. Anthem publishes no reauthorization lead time.[2][3][4][5][12]
Ask the plan: On the benefits call, ask whether the plan is fully insured and issued in Indiana (24/48-hour state clock) or self-funded (federal 72-hour / 15-day clock), and what turnaround Anthem quotes for ABA.
For fully insured Indiana plans, 760 IAC 1-38.1 sets the order. For a child whose parents are married or living together, "the plan of the parent whose birthday falls earlier in a calendar year" is primary (same birthday: the plan covering that parent longest). For divorced, separated or never-cohabiting parents without a court decree, the order is the custodial parent's plan, then the custodial parent's spouse's, then the noncustodial parent's. Self-funded plans follow their plan document. TRICARE is "last pay" (32 CFR 199.8). If the child also has Indiana Medicaid, this plan pays first; the provider "must also obtain PA from the appropriate IHCP PA contractor," and IHCP will not pay for services this plan denied as out-of-network.[6][7][8][9][10]
Ask the plan: Collect every coverage the child has, both parents' birthdays and any custody decree at intake, then ask each carrier whether its plan is fully insured or self-funded and which it shows as primary.
Not published. Neither IC 27-8-14.2 nor any Anthem Indiana commercial document we read states how recent the diagnostic evaluation must be. Anthem reviews ABA under MCG B-806-T, which is licensed and unpublished. What is published is the treatment-plan cadence: review or update at least every 6 months.[15][14]
In licensed criteria: Ask Anthem UM (Availity Essentials or the number on the member card) what evaluation age MCG B-806-T accepts for this request, and ask for the criteria in writing if a denial turns on it.
Not published for Indiana. The statute names no diagnosing credential; it requires only that treatment be prescribed by the treating physician under a treatment plan. Anthem's commercial Treatment Plan Request Form for ASD asks for a diagnostic report "completed by a doctorate level clinician or allowable qualified healthcare provider (QHCP) per state regulations," but that form's header lists ten states and Indiana is not one of them.[19][1]
Ask the plan: Anthem Indiana provider services or Availity Essentials: ask which diagnosing credentials Anthem accepts for an Indiana commercial ABA request and whether an Indiana-specific request form applies.
Not published for Indiana. The statute defines ASD by reference to the DSM and names no instrument. Anthem's ten-state commercial request form (which does not list Indiana) asks for "Standardized diagnostic tools (for example, … ADI-R; … ADOS-2; … CARS-2)." Send the full evaluation report with the instruments and scores either way.[18][1]
Ask the plan: Anthem Indiana provider services or Availity Essentials. MCG B-806-T is licensed and unpublished, so the reviewer is the only source for any instrument requirement.
Coverage decides whether Anthem Blue Cross and Blue Shield Indiana (commercial) 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 names who may render rather than a ratio: psychiatrists, psychologists, LCSWs, LPCs and LMFTs with ABA training or experience, BCBAs and BCBA-Ds, "providers practicing under the direction and supervision of the BCBA," and other state-licensed providers the plan recognizes. It publishes no supervision-hours floor. In Indiana, direct-contact technicians are exempt from licensure only while acting "under the extended authority and direction of a behavior analyst or assistant behavior analyst licensed under this chapter."[14][23]
A physician or other 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." Supervised or directed services billed with a QHP-performed procedure also fall under Anthem's Incident To Services and Billing reimbursement policy.[14]
No Indiana-specific per-day unit ceiling is published, and IC 27-8-14.2 sets no hour or visit limit. Anthem says "ABA codes may have associated MUE limits," which it administers as NCCI edits under its Code and Clinical Editing Guidelines policy, aligned to CMS MUE updates. The working ceiling is the units on the authorization.[14][19]
Every medical-record entry needs author identification (handwritten signature, unique electronic identifier or initials) and rendering-provider credentials. Entries are due at the time of service or shortly after and "should not exceed 30 days," with a "Signature date within 30 days of the date of service." Timed codes need total treatment time plus start and stop times, and treatment plans must show review or update "at a min of every 6 months."[14]
POS codes Anthem lists as frequently used for ABA: 12 home, 11 office/clinic, 99 community, 03 school, 10 telehealth with the member at home, 02 telehealth with the member elsewhere — "Subject to the member's coverage and reviews by the plan."[14]
"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," with degree-level modifiers HM (less than bachelor's), HN (bachelor's) or HO (master's) for the rendering staff. In Indiana the supervising analyst must hold an LBA or LABA license.[14][23]
Indiana law (IC 27-8-11-7) gives an insurer five business days to flag a deficiency in a completed application, and if it has not decided within 15 business days of a completed clean application it must provisionally credential the provider, with payment later retroactive to that date once the provider is credentialed and contracted.
Not for Indiana commercial members. Anthem's January 2026 preapproval list for Indiana, Kentucky, Missouri, Ohio and Wisconsin names Anthem as the responsible party for ABA, and Carelon Behavioral Health is not on it. Anthem told Indiana providers that a 2023 Carelon Behavioral Health assignment letter was an Ohio matter sent to them in error. Submit through Availity Essentials.
No. Anthem's Medicaid plans (Hoosier Healthwise, HIP, Hoosier Care Connect, PathWays) follow IHCP ABA rules and have their own guide. This guide covers Anthem commercial plans.
No. IC 27-8-14.2 sets no dollar, age, visit or hour limit. Its only limit is parity: dollar limits, deductibles and coinsurance can be no less favorable than for physical illness. Group policies must cover ABA; individual-policy insurers only have to offer it; self-funded employer plans are outside the statute.
MCG B-806-T since June 1, 2024, replacing CG-BEH-02 and MCG W0153. MCG criteria are licensed and not published, so ask the reviewer for the specific criterion when a request is denied.
No. Indiana licenses behavior analysts (LBA/LABA), not technicians. A direct-contact technician is exempt while acting under the direction of an Indiana-licensed analyst, and Anthem requires the supervising BCBA or QHP in box 31 of the claim.
Indiana requires an Indiana license (IC 25-8.5-3-6), and its telehealth law counts only Indiana-licensed behavior analysts as practitioners. Anthem’s ABA guide accepts BCBAs and providers “licensed or authorized by the state in which they practice”; confirm the license question with Anthem credentialing.
Indiana law (IC 27-8-5.7-6) requires an insurer to pay or deny a clean claim within 30 days of receipt if filed electronically and 45 days on paper; a deficiency not flagged within that window makes the claim clean. Self-funded employer plans are not bound by the statute.
Yes, if the member's product gives you network benefits through your local Blue contract. File the claim with your own local Blue plan, with the member's three-character prefix. Your local plan sends it to Anthem, which adjudicates it on the member's benefits and your local contract. Get ABA precertification from Anthem as the home plan, through Electronic Provider Access in your local Blue's portal or by calling 1-800-676-BLUE. Anthem's alpha-prefix router on anthem.com shows its general precertification rules. Precertification appeals go to Anthem, and claim questions go to your local Blue.
Anthem’s Indiana commercial provider manual sets no number of its own: the deadline is the one in your provider agreement, and rejected claims must be corrected and resubmitted inside that same window. Indiana’s prompt-pay statute then gives Anthem 30 days to pay or deny an electronic clean claim (45 on paper).
Anthem’s ABA provider resource guide sets no graph or data-format requirement for reviews — ask the Anthem behavioral health reviewer what the next review needs. It does require dated, signed documentation entered within 30 days, and lists only CPT 97151–97158, 0362T and 0373T for ABA.
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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