Blue Cross Blue Shield of North Dakota is the state’s dominant carrier and also runs the Medicaid Expansion plan for adults. For an ABA intake team the commercial card is the one that matters, and three layers decide the answer: the member’s own BCBSND contract, North Dakota’s Bulletin 2018-1 (there is no autism statute), and whether the employer plan is insured or self-funded.
BCBSND does not publish its ABA prior-authorization rules in a document we could read: its PA search needs the member ID and the provider’s NPI, and its medical policy library is a JavaScript-only search. This guide gives the parts that are written down (filing and appeal limits, telehealth claim routing, the 2027 migration, state law) and the questions to ask for the rest.
BCBSND says "The ordering provider is typically responsible for obtaining prior authorization" and sends providers to a search tool: "Use the search tool below to verify whether the service requires prior authorization," and "If you see no results for the code or search term entered, prior authorization is not required." The tool asks for the member’s ID, the provider’s NPI and the date of service, so the answer is member-specific. Requests go through Availity Essentials. The only ABA form BCBSND posts, the "ABA Form," is marked "For FEP use only," meaning Federal Employee Program members. The medical policy library ("Medical Policy Search") opens behind a disclaimer into a JavaScript search we could not read, so BCBSND’s ABA medical-necessity criteria are not quoted here.[1][2][4]
BCBSND is changing systems. Its provider manual (8-26) says it "is migrating members to new systems, policies and processes in phases through the end of 2027," and from January 1, 2027 "providers may see both migrated and non-migrated members." Migrated members use the Commercial Migrated Member Prior Authorization List; we read it in full and it names no ABA code (97151–97158, 0362T, 0373T), while its behavioral health section points to LOCUS, CALOCUS-CASII and to Regence’s behavioral health medical policies for criteria. Non-migrated members keep the current search tool. Ask which group the member is in before every new request.[1][2][4]
BCBSND posts a "Commercial Migrated Medical Policy" library for members moved to its new system (members migrate in phases on their plan anniversaries in 2027). Its ABA policy, BH18 (effective August 1, 2025; the PDF says a revised version takes effect November 1, 2026), "only applies to member contracts that are subject to preauthorization for Applied Behavior Analysis … as specified by their group plan." To start ABA it requires an ASD diagnosis "by a qualified treating health care professional, as defined by state law," impairment of communication, social or behavioral functioning, and that "ABA therapy must be recommended or prescribed by a qualified treating health care professional experienced in the diagnosis and treatment of ASD." The individualized treatment plan must be prepared by a provider certified to provide ABA, document each target behavior "using objective measurements and at least one standardized assessment" (examples: SRS-2, Vineland-3, ABAS-3, SSIS, BRIEF-2, PDDBI), justify days per week, hours per day and supervision hours, and list "CPT codes and units requested." The review packet adds a "Written recommendation, clinical order, or prescription for ABA services."[3]
Continuation under BH18 requires documented progress: goals tracked "using data collected during treatment sessions and/or assessments," "The same measurement tool that was used for baseline assessments," objective measurements "at a minimum of every six months," and standardized assessments "annually." The updated plan "should be submitted within five business days prior to the end of a current authorization (and no more than 30 days prior to the end of the authorization period)," and where goals show no progress the plan must give a barrier analysis and a modification plan. BH18 does not mention graphs. On staffing, BCBAs and BCBA-Ds "may oversee all aspects of assessment, treatment planning, and supervision," BCaBAs and behavior technicians/RBTs work under a BCBA, BCBA-D or qualified supervisor, and "All supervision must be conducted in accordance with" BACB standards; BH18 sets no numeric ratio, unit cap, place-of-service or concurrent-billing rule. It bills CPT 97151–97158, 0362T and 0373T ("HCPCS None").[3]
North Dakota has no autism insurance statute: chapter 26.1-36 of the Century Code, the accident and health insurance chapter, contains no autism or ABA section (§ 26.1-36-09.15, sometimes cited as the autism mandate, is the telehealth coverage section). The rule that binds insured plans is Insurance Department Bulletin 2018-1, issued July 10, 2018 to "all health insurance carriers choosing to cover Autism Spectrum Disorder," which says "treatments for Autism Spectrum Disorder cannot be excluded from an insurance policy." It rests on federal mental health parity: if a carrier covers autism and "seeks to place QTLs or NQTLs on autism spectrum disorder benefits or treatments, it must show that a similar limitation exists regarding substantially all benefits and treatments on the medical/surgical portion of their insurance coverage," and autism benefits "may not be subject to any separate cost-sharing requirements or treatment limitations that only apply to mental health/substance use disorder benefits." On ABA specifically: "exclusion of Applied Behavior Analysis (ABA) therapy to treat children with autism spectrum disorder on the basis that ABA therapy is experimental or investigative treatment will not be allowed by the Department." Carriers may still review medical necessity and periodically review continuing treatment, "as long as the standards for such reviews are comparable to and not more stringent than reviews conducted for substantially all medical/surgical services in the same classification." The bulletin defines treatment as care "prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist who determines the care to be medically necessary," including behavioral health treatment. It applied to grandfathered and transitional individual, small-group and large-group policies from October 1, 2018, and to non-grandfathered policies and Department-regulated self-funded multiple employer welfare arrangements from January 1, 2019. It sets no age or dollar cap of its own. Ordinary self-funded employer plans are not regulated by the Department and answer to ERISA and federal parity instead.[7][8][9]
North Dakota licenses behavior analysts. Under N.D.C.C. 43-64-02, "Effective January 1, 2020, an individual may not practice applied behavior analysis without a current license issued by the board," the State Board of Integrative Health Care. There are two licenses: licensed behavior analyst (a master’s or doctorate from an ABAI-accredited or BACB-approved program, the BCBA examination, current BACB certification, and the North Dakota professional responsibility examination "once developed and approved by the board") and licensed assistant behavior analyst (bachelor’s, the BCaBA examination, and proof of supervision by a licensed behavior analyst). Anyone who held a license or registration from the Board of Psychologist Examiners under chapter 43-32 on December 31, 2019 was grandfathered. The board’s exemptions include behavior technicians who "deliver applied behavior analysis services under the extended authority and direction of a licensed behavior analyst or a licensed assistant behavior analyst" (titles such as "registered behavior technician"), licensed psychologists practicing within competence, and people providing ABA in a public school setting. A BCBA licensed in another state can apply for license by endorsement: the board grants it when the applicant holds "a verified current valid license in good standing to practice as a behavior analyst professional in another state," passed the BACB examination, and the other state’s requirements are "substantially similar." We read chapter 43-64, chapter 43-57 and the full rule chapter 112-05-01 and found no exemption for an out-of-state behavior analyst treating a North Dakota child, in person or by telehealth, so plan on a North Dakota license before serving North Dakota members and confirm telehealth questions with the board. On rates: commercial ABA rates are negotiated and unpublished. The public benchmark is ND Medicaid’s professional fee schedule (August 1, 2026): 97153 $10.81 and 97155 $31.76 per unit.[12][13][14][15][20]
Timely filing: "BCBSND claims must be filed within 12 months, or length of time stated in the member’s benefit plan, of the date of service," and late claims are denied with the member and BCBSND held harmless; self-insured plans and other Blues may differ, so call Provider Services (800-368-2312). Claim corrections are allowed "for 180 days from the last processed claims processing date." Appeals: a pre-service appeal may be filed "within 180 calendar days from the notice of Adverse Benefit Determination," and "Any appeals received after 180 days will be returned to the provider without review." Supervised billing: BCBSND lets only listed "professionals in training" (for example post-doctoral psychology residents and master’s-level psychologists) bill under a supervising provider’s NPI, under direct supervision; behavior technicians are not on that list, so ask how BCBSND wants technician time billed.[4][9][10]
North Dakota’s claim-payment statute, N.D.C.C. 26.1-36-37.1, gives an insurer 15 business days after receiving a proof of loss to "pay the claim or that portion of the claim that is not contested, deny the claim, or make an initial request for additional information," and another 15 business days after receiving the information to pay or deny; a contested claim must be explained in writing. That binds insured policies, not self-funded ERISA plans. Prior authorization for insured plans runs under chapter 26.1-36.12 (seven calendar days after complete information, 72 hours if urgent, missed deadlines deemed approved; see the turnaround field below). Timely-filing limits and the rendering-versus-supervising NPI rule are set by each carrier’s contract, not by state law.[4][9][10]
BCBSND’s telehealth guide says local providers "have the option to use telehealth as a modality when treating their patients" and file claims to their local plan through BlueCard. For a clinician physically outside North Dakota but employed by a brick-and-mortar group in North Dakota, claims for a BCBSND member in the service area "are filed to BCBSND," and the claim "should include address of where the clinician is employed." Contracting questions go to providercontracting@bcbsnd.com. That is claim routing, not licensure: the clinician still needs a North Dakota behavior-analyst license to practice ABA on a North Dakota child.[5][12]
The questions that decide whether a family can start with Blue Cross Blue Shield of North Dakota, and what they have to bring. Each maps onto something intake should ask on the first call.
BCBSND publishes no ABA age limit we could read; the member’s contract governs. North Dakota has no autism statute, and Bulletin 2018-1 sets no age or dollar limit: for insured plans it bars autism-only limits that are more restrictive than those on medical/surgical benefits, and bars excluding ABA as experimental (its ABA paragraph speaks of "children with autism spectrum disorder"). Self-funded ERISA plans are outside the bulletin, so plan funding type decides whether it binds.[1][7]
Ask the plan: Availity benefits check or Provider Service, 800-368-2312: establish insured vs. self-funded first, then the plan’s ABA terms.
BCBSND publishes no ABA referral rule. Its prior-authorization page says the ordering provider is "typically responsible for obtaining prior authorization"; its provider manual (8-26) lists an "ABA Service for Autism Spectrum Disorder Request" fax form for FEP members only and asks for the NPI of the "referring, ordering or supervising provider" in CMS-1500 item 17b. Network referrals matter on DakotaBlue: care outside the member’s selected network without an Authorized Referral pays at the out-of-network level, and "Only Tier 1 preferred providers can initiate a referral." For migrated members, policy BH18 says "ABA therapy must be recommended or prescribed by a qualified treating health care professional experienced in the diagnosis and treatment of ASD" and the review packet needs a "Written recommendation, clinical order, or prescription for ABA services." North Dakota has no autism statute requiring a referral. For insured plans, Bulletin 2018-1 defines treatment as "evidence-based care and related equipment prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed psychologist who determines the care to be medically necessary." The bulletin sets no order form, contents or validity period, so the practical route is a written order or recommendation for ABA from the diagnosing physician or psychologist (often inside the diagnostic report), kept on file. Single-employer self-funded ERISA plans sit outside the bulletin.[3][1][4][7]
Ask the plan: Availity or Provider Service, 800-368-2312: ask whether the member’s plan (DakotaBlue or other) needs an Authorized Referral or a physician or psychologist order for ABA.
BCBSND’s telehealth guide lets local providers use telehealth "as a modality" and sets claim routing (in-area members’ claims to BCBSND; a clinician outside the state employed by a North Dakota group files to BCBSND with the employer’s address), but names no ABA telehealth code list or POS. For an insured North Dakota policy, N.D.C.C. 26.1-36-09.15 requires coverage "for health services delivered by means of telehealth which is the same as the coverage for health services delivered by in-person means," lets payment be negotiated "in the same manner" as in-person rates, and does not require a provider at the originating site. Its definition of "health care provider" lists licensees under named chapters, including psychologists (43-32), but not behavior analysts (43-64), so whether a behavior analyst’s telehealth falls inside the statute is not settled by its text. Self-funded employer plans are outside the statute.[5][9]
Ask the plan: BCBSND Telehealth medical policy (Medical Policy Search) or Provider Service, 800-368-2312: ask which ABA codes, POS and modifier it pays by telehealth.
Depends on how the plan is funded. Insured North Dakota plans fall under N.D.C.C. ch. 26.1-36.12: a non-urgent decision is due "within seven calendar days of obtaining all necessary information," an urgent one within 72 hours, and if the provider or family does not supply requested information within 14 calendar days of a written request the carrier "may make an adverse determination." A prior authorization is valid for at least six months (12 months for "a chronic or long-term care condition"), cannot be revoked "if care is provided within forty-five business days" of approval, and a new carrier must honor a prior plan’s authorization for the first 60 days of coverage. If the carrier misses a deadline, "any health care services subject to review automatically are deemed authorized." Requirement changes need 60 days’ written notice to contracted providers. The chapter does not reach Medicaid or the state employees’ PERS plan. 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. BCBSND publishes no North Dakota-specific ABA turnaround or reauthorization lead time.[10][16]
Ask the plan: At benefits verification ask whether the plan is insured in North Dakota (ch. 26.1-36.12 applies) or self-funded (ERISA), and what reauthorization lead time BCBSND expects.
For a child on two group plans, North Dakota follows the birthday rule: for parents who are married or living together, "The plan of the parent whose birthday falls earlier in the calendar year is the primary plan" (N.D. Admin. Code 45-08-01.2); a court decree controls for separated parents, and otherwise the custodial parent’s plan pays first. That rule binds plans regulated by the state; a self-funded plan sets its own order. If the child also has ND Medicaid, BCBSND pays first: ND Medicaid is "generally the payer of last resort," pays only the member responsibility up to its allowed amount, and expects providers "to follow TPL payer policy and procedures for payment," so be in the commercial network and get its authorization. TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270).[11][17][18][19]
Ask the plan: Ask BCBSND 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.
No diagnosis-age rule in migrated-member policy BH18 (it requires a diagnosis but no date window); the non-migrated policy was not readable.[1]
Blocked on: BCBSND Medical Policy Search (ABA policy) or Provider Service, 800-368-2312.
Migrated-member policy BH18: "a qualified treating health care professional, as defined by state law" (no specialty list); the non-migrated policy was not readable. Bulletin 2018-1 defines insured-plan autism treatment as care prescribed or ordered "by a licensed physician or a licensed psychologist."[3][1][7]
Blocked on: BCBSND Medical Policy Search (ABA policy) or Provider Service, 800-368-2312.
Migrated-member policy BH18 names no diagnostic instrument; its standardized-assessment list (SRS-2, Vineland-3, ABAS-3, SSIS, BRIEF-2, PDDBI) is for the treatment plan’s baseline, not the diagnosis. The non-migrated policy was not readable.[3][1]
Blocked on: BCBSND Medical Policy Search (ABA policy) or Provider Service, 800-368-2312.
Coverage decides whether Blue Cross Blue Shield of North Dakota 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.
No numeric ratio is published. For migrated members, policy BH18 says BCBAs/BCBA-Ds "may oversee all aspects of assessment, treatment planning, and supervision of support staff," BCaBAs and behavior technicians/RBTs work under a BCBA, BCBA-D or qualified supervisor, and "All supervision must be conducted in accordance with" BACB standards; the treatment plan must justify "the hours per week of direct face-to-face supervision." The non-migrated policy was not readable. North Dakota law requires ABA to be practiced by a licensed behavior analyst, with technicians exempt only when working "under the extended authority and direction of" a licensed behavior analyst or licensed assistant behavior analyst.[3][4][13]
Blocked on: Ask whether the member is migrated (BH18) or non-migrated; for non-migrated members, BCBSND Medical Policy Search (ABA policy) or Provider Service, 800-368-2312.
Not published in a BCBSND document we could read.[4]
Blocked on: BCBSND Coding & Reimbursement policies or Provider Service, 800-368-2312: ask whether 97153 and 97155 may be billed for the same time.
No unit cap is published: migrated-member policy BH18 sets none (hours must be clinically justified, and excessive supervision, assessment, social-skills or parent-training hours need justification); the non-migrated policy was not readable. Bulletin 2018-1 bars autism-only treatment limits stricter than those on medical/surgical benefits in insured plans.[3][4][7]
Blocked on: BCBSND Medical Policy Search or the member’s benefit summary in Availity.
The provider manual sets no ABA session-note signature rule.[4]
Ask the plan: BCBSND Provider Service, 800-368-2312, or the documentation terms of your provider agreement.
Not published in a BCBSND document we could read.[4]
Blocked on: BCBSND Medical Policy Search (ABA policy) or Provider Service, 800-368-2312: ask which settings (home, clinic, school, community) and POS codes it pays.
BCBSND’s manual lets only listed professionals in training (for example post-doctoral psychology residents, master’s-level psychologists, LAMFTs) bill under a supervising provider’s NPI, with the supervisor "present in the office suite and/or on a virtual care visit and immediately available." Behavior technicians are not listed, and no ABA-specific billing rule was found.[4]
Ask the plan: BCBSND provider contracting (providercontracting@bcbsnd.com) or Provider Service, 800-368-2312: ask whether RBT time is billed under the supervising licensed behavior analyst’s NPI.
It depends on the member’s plan. For insured plans that cover autism, Bulletin 2018-1 bars excluding ABA as experimental and bars autism-only limits stricter than medical limits. Self-funded employer plans follow their own documents. Check benefits in Availity.
BCBSND does not publish a general answer: its PA search is member-specific (member ID, NPI, date of service) and says no result means no PA is required. Members migrated to its new system from January 1, 2027 use a published list that names no ABA code. Check every code before starting.
For migrated members, policy BH18: an updated treatment plan sent within five business days before the authorization ends (no more than 30 days before), with progress from session data, the same measurement tool as the baseline, objective measures at least every six months and standardized assessments yearly, plus a barrier analysis for any stalled goal. BH18 does not require graphs.
12 months from the date of service, or the limit in the member’s benefit plan; self-insured plans may differ. Appeals must be filed within 180 days.
No statute. North Dakota relies on Insurance Department Bulletin 2018-1, which applies federal parity to insured plans and forbids excluding ABA as experimental.
Only with a North Dakota license: N.D.C.C. 43-64-02 requires one to practice ABA in the state, and the Board of Integrative Health Care offers license by endorsement. BCBSND’s telehealth guide covers claim routing for out-of-state clinicians employed by North Dakota groups, not licensure.
BCBSND’s provider manual (8-26): BlueCard lets participating providers "submit claims for members who are enrolled through another Blues Plan to their local BCBS Plan." Verify the out-of-state member on Availity or at BlueCard Eligibility, 800-676-BLUE (2583), using the prefix on the ID card. File the claim with that prefix and ID number to the plan you contract with (your local plan unless you contract directly with the member’s plan); the member’s own plan adjudicates it, and payment is based on your local plan’s arrangement. For authorizations the manual says only "see the member’s ID card," so use the authorization contact printed there. Contiguous-county contracts with Blue Cross of Minnesota change where some claims go, as the manual’s examples show.
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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