---
title: "Anthem commercial ABA in Indiana: who reviews it, and which rules apply."
url: "https://carelu.com/payers/anthem-indiana"
markdown_url: "https://carelu.com/payers/anthem-indiana.md"
state: IN (Indiana)
payer: Anthem Blue Cross and Blue Shield Indiana (commercial)
kind: Commercial insurance
description: "How Anthem's Indiana commercial plans handle ABA: Anthem (not Carelon Behavioral Health) owns the preapproval, the uncapped IC 27-8-14.2 mandate and who it misses, Indiana LBA licensure, and the claim rules in Anthem's ABA resource guide."
last_reviewed: September 2026
---

# Anthem commercial ABA in Indiana: who reviews it, and which rules apply.

_Payer Guide · Anthem · Indiana commercial · Last updated September 2026 · 13 primary sources_

> Anthem commercial in Indiana: ABA precert stays with Anthem, not Carelon Behavioral Health; uncapped IC 27-8-14.2 mandate.

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.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment** _(plan-dependent)_: Yes — applied behavioral analysis is on Anthem's Indiana commercial preapproval list with Anthem as the responsible party; the list names the category, not individual CPT codes [1][2]
  - Ask the plan: The list applies to local fully insured members and to self-insured (ASO) members only where the group bought the medical-management program ("If the program has not been purchased, preapproval is not required, and clinical review will not be performed"); on National Accounts, ABA precertification "applies unless the group specifically opts out of clinical review for this benefit." Confirm funding type and program purchase on the benefits call or in Availity Essentials.
- **Prior auth for treatment** _(plan-dependent)_: Yes — Anthem is the responsible party for ABA preapproval on Indiana Blues products, reviewed under MCG B-806-T since June 1, 2024 [1][4][2]
  - Ask the plan: Same scope limits as the assessment: fully insured members, and ASO members only where the group bought medical management; National Accounts groups may opt out of clinical review, and "Retrospective review is allowed." Confirm on the benefits call.
- **Autism diagnosis required?**: Yes — autism spectrum disorder as defined in the DSM, and the mandated coverage is limited to treatment "prescribed by the insured's treating physician in accordance with a treatment plan" [7][8]

## At a glance

- **Line of business:** Commercial (Anthem Insurance Companies, Inc.) — not the anthem-indiana-medicaid guide
- **Who reviews ABA:** Anthem — responsible party on the IN/KY/MO/OH/WI preapproval list; Carelon Behavioral Health is not on it
- **Criteria:** MCG B-806-T (licensed, unpublished) — replaced CG-BEH-02 on June 1, 2024
- **Precert scope:** Fully insured members; ASO groups only if they bought medical management; National Accounts may opt out
- **State mandate:** IC 27-8-14.2 — group policies must cover, individual policies must offer; IC 27-13-7-14.7 for HMOs
- **Mandate caps:** None — no dollar, age, visit or hour limit; cost-share parity with physical illness
- **Outside the mandate:** Self-funded ERISA plans; short-term, student, specified-disease and other excepted policies
- **Licensure:** Indiana LBA / LABA (applications live since May 13, 2025); technicians work under a statutory exception

## Anthem owns the ABA review, not Carelon Behavioral Health

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. [1][5][4]

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. [1][5][4]

## Funding decides whether there is a review at all

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." [1][2][6]

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. [1][2][6]

## Indiana's mandate: group must cover, individual must offer, nothing capped

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. [8][9][10][7]

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." [8][9][10][7]

## Indiana licenses behavior analysts

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. [13][11][12]

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. [13][11][12]

## Claim and documentation rules in Anthem's ABA resource guide

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. [3]

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. [3]

## Intake gates

The questions that decide whether a family can start with Anthem Blue Cross and Blue Shield Indiana (commercial), and what they have to bring.

- **Age limit**: 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. [8][10]
- **Referral required?**: 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. [8][9]
- **Telehealth** _(plan-dependent)_: 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. [3][12]
  - Blocked on: Anthem's Virtual Visits reimbursement policy and its Indiana allowed-virtual-services list, or Anthem provider services, before scheduling remote hours.
- **Prior-auth decision time** _(plan-dependent)_: 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. [15][16][17][18][1]
  - 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.
- **Other insurance (who pays first)** _(plan-dependent)_: 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. [19][20][21][22][23]
  - 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.
- **Diagnosis recency** _(licensed criteria)_: 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. [4][3]
  - 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.
- **Who may diagnose** _(ask the plan)_: 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. [8][14]
  - 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.
- **Diagnostic tools required** _(ask the plan)_: 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. [7][14]
  - 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.

## Delivery and billing rules

Coverage decides whether Anthem Blue Cross and Blue Shield Indiana (commercial) 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**: 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." [3][12]
- **Concurrent billing (97153 + 97155)**: 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. [3]
- **Daily limits / MUEs**: 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. [3][8]
- **Session-note signature**: 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." [3]
- **Place of service**: 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." [3]
- **Bill as provider**: "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. [3][12]

## What intake should collect for Anthem Blue Cross and Blue Shield Indiana (commercial)

- **Commercial or Medicaid:** Anthem runs both lines in Indiana and they follow different rulebooks. A Hoosier Healthwise, HIP, Hoosier Care Connect or PathWays card belongs in the Medicaid guide.
- **Funding type and program purchase:** Fully insured, self-funded (ASO) with or without Anthem's medical-management program, or a National Account. This decides whether precert applies and whether IC 27-8-14.2 applies.
- **Group or individual policy:** Group policies must cover ABA. Individual-policy insurers only have to offer it, so check the individual plan's benefit.
- **Treating physician's prescription and treatment plan:** The mandate covers treatment "prescribed by the insured's treating physician in accordance with a treatment plan." Capture both.
- **Diagnostic report:** DSM-based ASD diagnosis, the diagnosing clinician and credentials, the instruments used and the evaluation date. The full report, not a one-line letter.
- **Indiana LBA/LABA licence numbers:** For every analyst on the case. Technicians need a named licensed supervisor on the claim (box 31).

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

## Common questions

### Does an Anthem ABA request in Indiana go to Carelon Behavioral Health?

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.

### Is this the same as Anthem Indiana Medicaid?

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.

### Does Indiana's autism mandate cap ABA?

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.

### Which criteria does Anthem use?

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.

### Do technicians need an Indiana license?

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.

## Primary sources

1. [Anthem and CDHP products Precertification/Prior Authorization List — IN, KY, MO, OH, WI (updated January 1, 2026)](https://www.anthem.com/content/dam/digital/docs/provider/commercial/guides/Central_Blues_CDHP_PA_List.pdf)
2. [Anthem National Accounts 2026 standard prior authorization requirements](https://www.anthem.com/content/dam/digital/docs/provider/commercial/general/ANA_SPL.pdf)
3. [Anthem ABA Provider Resource Guide — commercial, 11 states incl. Indiana (June 2025)](https://www.anthem.com/content/dam/digital/docs/provider/commercial/guides/aba-provider-resource-guide-abcbs.pdf)
4. [Anthem Indiana — MCG care guidelines 27th edition update (Commercial; CG-BEH-02 to MCG B-806-T for ABA, eff. June 1, 2024)](https://providernews.anthem.com/indiana/articles/mcg-care-guidelines-27th-edition-update-17867-17867)
5. [Anthem Indiana — Carelon Behavioral Health assignment mailing sent in error to non-Ohio providers (Commercial)](https://providernews.anthem.com/indiana/articles/important-information-regarding-the-recent-carelon-behaviora-1-13957)
6. [Ind. Code § 27-8-14.2-1 — policies excluded from the chapter](https://law.justia.com/codes/indiana/title-27/article-8/chapter-14-2/section-27-8-14-2-1/)
7. [Ind. Code § 27-8-14.2-3 — definition of autism spectrum disorder](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-8-14-2-3/)
8. [Ind. Code § 27-8-14.2-4 — group coverage](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-8-14-2-4/)
9. [Ind. Code § 27-8-14.2-5 — individual offer](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-8-14-2-5/)
10. [Ind. Code § 27-13-7-14.7 — HMO coverage](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-13-7-14-7/)
11. [Ind. Code § 25-8.5-3-1 — licensure requirements](https://codes.findlaw.com/in/title-25-professions-and-occupations/in-code-sect-25-8-5-3-1/)
12. [Ind. Code § 25-8.5-3-6 — practice restriction and exceptions](https://law.justia.com/codes/indiana/title-25/article-8-5/chapter-3/section-25-8-5-3-6/)
13. [Indiana PLA — Behavior Analyst](https://www.in.gov/pla/professions/behavior-analyst/)
14. [Anthem — Treatment Plan Request Form for Autism Spectrum Disorders (commercial, December 2025; GA, KY, ME, MO, NV, NH, NY, OH, VA, WI)](https://www.anthembluecross.com/content/dam/digital/docs/anthembluecross/provider/commercial/forms/NY_BH_00001.pdf)
15. [Ind. Code 27-1-37.5-23 — prior authorization response deadlines](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-23/)
16. [Ind. Code 27-1-37.5-5 — “health plan” definition](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-5/)
17. [Ind. Code 27-1-37.5-28 — missed deadline = deemed authorized](https://codes.findlaw.com/in/title-27-insurance/in-code-sect-27-1-37-5-28/)
18. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
19. [760 IAC 1-38.1-13 — dependent child, parents not separated or divorced](https://www.law.cornell.edu/regulations/indiana/760-IAC-1-38.1-13)
20. [760 IAC 1-38.1-14 — dependent child, separated or divorced parents](https://www.law.cornell.edu/regulations/indiana/760-IAC-1-38.1-14)
21. [32 CFR 199.8 — TRICARE double coverage (eCFR)](https://www.ecfr.gov/current/title-32/section-199.8)
22. [IHCP — Prior Authorization module (PROMOD00012)](https://www.in.gov/medicaid/providers/files/modules/prior-authorization.pdf)
23. [IHCP — Third-Party Liability module (PROMOD00017)](https://www.in.gov/medicaid/providers/files/modules/third-party-liability.pdf)

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.