Blue Cross Community Health Plans (BCCHP) is Blue Cross and Blue Shield of Illinois’s HealthChoice Illinois plan, statewide. It lists every ABA code on its prior authorization code list, reviews them against MCG B-806-T, and since January 1, 2026 asks for notification within 24 hours of starting adaptive behavioral support, with review after that.
BCBSIL’s Medicaid authorization summary (effective January 1, 2026, updated March 2026) says: “For outpatient behavioral health care, including partial hospitalization, intensive outpatient treatment and adaptive behavioral support services providers should notify us within 24 hours of initiation of services. Utilization review may begin after the 24-hour notification period. All services will be reviewed for medical necessity and require authorization for utilization beyond the notification period.” Notification goes through “your current method of requesting authorization.” BCBSIL’s January 2026 provider notice says the same for BCCHP and names applied behavior analysis expressly.[15][16][2][6][3][17][18][19][20]
The BCCHP prior authorization code list (10/1/2026) carries all ten ABA codes with a January 1, 2026 effective or change date: 97151 and 97152 with the ABA Initial Assessment Request form, 97153 through 97158 with the ABA Clinical Service Request form, and 0362T and 0373T with documentation of medical necessity. The criteria are MCG B-806-T, licensed criteria BCBSIL does not publish. Out-of-network providers need prior authorization for everything, and every provider must be registered in IMPACT.[15][16][2][6][3][17][18][19][20]
Illinois Public Act 104-0028 (HB 3019) changed behavioral health utilization management from January 1, 2026, and each HealthChoice Illinois plan has read it differently for ABA. Molina says ABA “services are no longer eligible for prior authorization and require concurrent review only” (no authorization for the initial assessment or the first 48 units of therapy a calendar year). Aetna Better Health approves 97151/97152 without medical-necessity review if notified within one business day, then runs concurrent review. Blue Cross Community Health Plans and YouthCare ask for notification within 24 hours of starting ABA services or the initial assessment. Meridian requires notice within 24 hours of 97151/97152 from May 1, 2026 and keeps prior authorization on treatment. CountyCare removed PA from 97151/97152 only. The Act itself added subsection (w) to 215 ILCS 5/370c: from January 1, 2026 “No policy shall require prior authorization for outpatient or partial hospitalization services for treatment of mental, emotional, or nervous disorders or conditions,” such coverage “may be subject to concurrent and retrospective review,” and “A Medicaid managed care organization may set a deadline of 24 hours after the initiation of treatment” for notification (one more business day if it cannot accept the notice). It also lets HFS “adopt rules to implement the applicable provisions” for managed care organizations “and the medical assistance fee-for-service program” (new 305 ILCS 5/5-5.28). The statute does not name ABA, which is why the plans differ; this guide reports each plan’s own written rule.[15][16][2][6][3][17][18][19][20]
BCBSIL’s May 2026 billing reminder for ABS providers: report “the attested provider rendering the services” as the rendering provider (CMS-1500 box 24J; 837P loop 2310B, NM1), and “the attested supervising ABS clinician as the supervising provider on claims that identify a registered behavior technician as the rendering or servicing provider” (box 17; loop 2310D, NM1). “Claims received with a rendering provider who differs from the authorization or medical record documentation may be denied for noncompliance.” BCCHP’s first-file timely filing limit is 180 days from the date of service (from the last date when the claim spans a range), and corrected claims are also due within 180 days. Illinois law sets the payment clock for every HealthChoice Illinois plan: under 305 ILCS 5/5-30.1(g), “The MCO shall pay a claim within 30 days of receiving a claim that contains all the essential information needed to adjudicate the claim,” must notify the billing party within 30 days when it cannot adjudicate a claim, and owes a late-payment penalty at least equal to the Insurance Code’s timely-payment interest, calculated and paid within 30 days after the claim is paid, without the provider having to ask for it. No plan document we read publishes a weekly submission cutoff or check-run day; ask the plan’s provider services for its payment cycle.[5][4][1]
The questions that decide whether a family can start with Blue Cross Community Health Plans (BCBSIL Medicaid), and what they have to bring. Each maps onto something intake should ask on the first call.
Under 21: HFS covers ABS for children 0 through 20; BCCHP publishes no different limit.[21][3]
BCCHP needs no referral to in-network specialists, but HFS’s ABS benefit requires a physician order, valid one year, and BCCHP’s ABA forms ask for documentation of medical necessity.[4][8][3]
BCCHP publishes no ABA telehealth rule, so HFS’s applies. HFS’s ABS fee schedule (updated 05/14/2026) marks four codes for remote delivery: 97151 (assessment), 97155 (protocol modification), 97156 (family guidance) and 97157 (multiple-family group). The footnote reads: “Only use the GT or 93 modifier when providing allowable service remotely as a distant site telehealth service along with Place of Service (POS) 02 or 10, as applicable, on the specific service line of the claim.” 97152, 97153, 97154, 97158, 0362T and 0373T carry no telehealth modifier, so technician-delivered treatment is billed as in-person.[4][10]
BCCHP manual (January 2026): routine decisions “no later than 5 calendar days from receipt of request” (5 more with an extension); urgent decisions and notice within 48 hours. ABS services are notified within 24 hours of initiation, with review after.[4][2]
BCCHP publishes nothing beyond MCG B-806-T, which is licensed. HFS’s rule: a CDE older than 24 months needs current functional-impairment documentation.[3][8]
In licensed criteria: BCBSIL Medicaid UM, 877-860-2837: ask what the ABA Initial Assessment Request form requires on diagnosis date.
Not stated by BCCHP. HFS: the CDE is performed by a physician or clinical psychologist.[3][8]
In licensed criteria: BCBSIL Medicaid UM, 877-860-2837.
Not stated by BCCHP. HFS: ADOS, GARS, ADI or CARS.[3][8]
In licensed criteria: BCBSIL Medicaid UM, 877-860-2837.
The BCCHP manual read has no ABA-specific COB rule. Medicaid is payer of last resort (42 CFR 433.139; HFS Chapter 100), so bill the primary first.[12][22]
Ask the plan: BCBSIL Medicaid provider services (number on the card): ask how BCCHP wants secondary ABA claims and whether it requires its own authorization when commercial coverage is primary.
Coverage decides whether Blue Cross Community Health Plans (BCBSIL Medicaid) 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.
BCCHP publishes no ABA supervision ratio in the documents read. HFS’s rule applies: RBTs “must receive supervision from a BCBA,” with Case Leadership of 5% or more of direct services and two face-to-face contacts a month in HFS’s ABS guidance. MCG B-806-T may add requirements but is licensed and not public.[3][9][8]
Rendering provider in CMS-1500 box 24J / 837P loop 2310B; when an RBT renders, the supervising ABS clinician in box 17 / loop 2310D. A rendering provider that differs from the authorization or record “may be denied for noncompliance.”[5][8]
Not addressed in the BCCHP manual, summary or code list.[4][3]
Ask the plan: BCBSIL Medicaid Utilization Management, 877-860-2837, or your BCCHP agreement.
No ABA unit limits appear in the BCCHP documents read; hours are set at review against MCG B-806-T, which is licensed. HFS’s fee schedule daily maximums (97153 32 units, 97155 24) are the state benchmark.[3][10]
In licensed criteria: BCBSIL Medicaid UM, 877-860-2837: ask how ABA hours are authorized after the 24-hour notification window.
Not addressed in the BCCHP documents read. BCBSIL warns that a rendering provider who differs from the authorization or the medical record can lead to denial, so sign notes as the clinician billed.[5][4]
Ask the plan: BCBSIL Medicaid provider services (number on the member card) or your BCCHP agreement.
All ABA codes are on BCCHP’s PA code list, but since January 1, 2026 you notify BCBSIL within 24 hours of starting adaptive behavioral support and review can begin after that. Services beyond the notification period need authorization.
The ABA Initial Assessment Request form for 97151/97152 and the ABA Clinical Service Request form for 97153–97158, per the BCCHP code list.
The rendering provider in box 24J (loop 2310B). When an RBT renders, the supervising ABS clinician goes in box 17 (loop 2310D).
No. BCCHP is BCBSIL’s Medicaid plan and follows HFS’s ABS benefit and the 24-hour notification rule; commercial BCBSIL plans have their own ABA PA list and phone-based preservice process.
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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