CareSource sells an Indiana Marketplace (ACA exchange) plan as well as the Indiana Medicaid plan in its own guide (caresource-indiana). They share a brand, not a rulebook. The Medicaid plan follows IHCP criteria. The Marketplace plan follows its Evidence of Coverage and CareSource's Marketplace ABA policy, MP-MM-1329, which covers Georgia, Indiana, Ohio and West Virginia and takes effect in its current form on October 1, 2026.
The 2026 Indiana Marketplace EOC lists "Adaptive Behavior Treatment, including Applied Behavioral Analysis (ABA)" under Autism Spectrum Disorder Services with the benefit limit "None." Unlike Medicaid, the family pays the deductible, copayment and coinsurance shown in their Schedule of Benefits. The diagnosis rule is stricter than most: MP-MM-1329 accepts a diagnosis only from four named specialist types, independent of the ABA provider.
A CareSource card in Indiana tells you little until you know the product. The Marketplace plan has its own EOC, prior authorization list, network and cost sharing. Being in network for CareSource Medicaid does not make a practice in network for the Marketplace plan, and the Medicaid ABA rules do not carry across.[6][7][9]
The Marketplace prior authorization list (PA-INMP(2026)) includes "Applied behavioral analysis (ABA)." Services from a non-network provider need prior authorization for everything, not just listed services. Requests go through the CareSource Provider Portal ("the preferred and faster method"), by phone at 1-833-230-2101, or in writing on the Medical Prior Authorization Request Form to CareSource, P.O. Box 1307, Dayton, OH 45401-1307.[6][7][9]
The EOC says "The Plan provides Benefits for Covered Persons to diagnose and treat Autism Spectrum Disorders," covering "Medically Necessary evidence-based treatment" prescribed or ordered for a diagnosed individual. In its benefit table, adaptive behavior treatment including ABA carries the benefit limit "None." Physical, speech and occupational therapy for autism are "Included in Habilitative Benefits," which the same EOC caps at 20 visits each. ABA must be "provided as prescribed by or under the supervision of a professional who is licensed; certified; or registered by an appropriate agency of this state to perform the services in accordance with a treatment plan."[6][11]
Cost sharing applies: "Deductible, Copayment, and Coinsurance amounts are listed in the Schedule of Benefits." Under the EOC's behavioral health parity clause, those amounts can be no less favorable than the ones for a physical sickness. For an individual policy, Indiana's mandate (IC 27-8-14.2-5) only requires the insurer to offer autism coverage, so the EOC is the document that puts ABA in this plan. Quote the family's deductible status and coinsurance along with the benefit.[6][11]
CareSource "uses MCG Health for the review of medical necessity criteria for ABA" and adds documentation rules of its own. To start ABA it needs a "definitive, primary diagnosis of ASD and the ASD level" from a child and adolescent psychiatrist, clinical psychologist, child neurologist or developmental pediatrician. That clinician must evaluate "independent of the ABA provider and with a relationship with the member." It also needs the standardized diagnostic tools used (for example ADOS, ADI-R or CARS-2). If the diagnostic evaluation is more than 24 months old, add a description of clinical symptoms present within the past year.[8]
A licensed ABA practitioner then completes a behavioral assessment (generally no more than 8 hours every 6 months) and a treatment plan before services start. The assessment must be no more than 2 months old when treatment is requested. The initial plan generally runs 26 weeks and must include biopsychosocial history, IEP/504 information, school placement and hours, SMART goals, requested weekly hours, a discharge plan and a parent/caregiver training plan signed by the caregiver.[8]
Caregiver coaching is required in every ABA request: at least 2 hours a month or 12 hours per standard 6-month authorization, and up to 18. If the minimum is not met, "other authorized ABA units may be reduced in subsequent authorization periods." Continuation requests go in every 6 months. Two successive 6-month periods without meaningful progress on standardized assessments is a discontinuation criterion.[8]
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.[14][15][16]
We have not verified CareSource Marketplace’s own credentialing rule for out-of-state BCBAs; ask CareSource provider relations, and expect it to look to Indiana licensure.[14][15][16]
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.[17][18]
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. CareSource Marketplace 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.[20]
CareSource’s Indiana Marketplace notice IN-EXCP-0163 (effective April 1, 2020): “Claims must be filed within 90 days from the date of service, or as defined within the provider contract,” down from 365 days, and the notice “supersedes information published in the CareSource Marketplace Provider Manual, or other materials.” Corrected claims follow the same clock: they “must be submitted within 90 days of the date of service or discharge.” The change “does not impact dispute or appeal filing requirements.” CareSource’s Indiana Health Partner Orientation (issued May 30, 2025) still lists the limit for “Medicaid (HHW & HIP) and Marketplace” as “90 days from date of service or discharge.” For ABA billed weekly or monthly, that leaves little slack: submit each month’s sessions well inside the 90 days.[21][22]
The questions that decide whether a family can start with CareSource Indiana Marketplace, and what they have to bring. Each maps onto something intake should ask on the first call.
None published. The 2026 EOC sets no age limit on autism services, MP-MM-1329 sets none (it says ABA "should begin early in life, ideally by the age of 2, typically lasting 3 to 4 years"), and IC 27-8-14.2 has no age cap.[6][8][11]
An older diagnosis is accepted with an update: if "the diagnostic evaluation was completed more than 24 months from the date of the request," add a "description of clinical symptoms (eg, provider letter) present within the past year that require treatment." Separately, the behavioral assessment "should not be older than 2 months when requesting an authorization for treatment services."[8]
One of four specialists, "upon evaluation independent of the ABA provider and with a relationship with the member": a child and adolescent psychiatrist, a clinical psychologist, a child neurologist or a developmental pediatrician. A general pediatrician or the ABA agency's own clinician does not qualify under the policy text.[8]
"Standardized diagnostic assessment tools used as part of a referral for services (eg, Autism Diagnostic Observation Schedule [ADOS], Autism Diagnostic Interview Revised [ADI-R], Childhood Autism Rating Scale, 2nd edition [CARS-2])." The treatment plan also needs a standardized skills assessment such as VB-MAPP or ABLLS-R.[8]
The EOC covers ASD treatment "prescribed or ordered for an individual diagnosed with an Autism Spectrum Disorder," and ABA is provided "as prescribed by or under the supervision of" a state-licensed, certified or registered professional under a treatment plan. MP-MM-1329 expects the diagnostic tools "as part of a referral for services." No separate PCP referral form is named.[6][8]
The 2026 EOC lists urgent care reviews "Within twenty-four (24) hours from the receipt of request" and preservice reviews "Within forty-eight (48) hours from the receipt of the request." That matches IC 27-1-37.5-23, which excludes weekends and state and federal holidays; a missed deadline means the service "shall be automatically deemed authorized" (IC 27-1-37.5-28). Continuation requests are due every 6 months.[6][12][1]
"Telehealth services may be provided when appropriate in instances deemed medically necessary with supporting documentation that provides a plan for the provision of service delivery, primarily adaptive behavior treatment with protocol modification or family adaptive behavior treatment guidance" — the 97155 and 97156 services. No code list or POS is published, and services from an in-state provider while the member is out of state are excluded.[8]
Ask the plan: Include the telehealth delivery plan in the PA request and confirm payable codes with CareSource Provider Services (1-833-230-2101).
The EOC's COB section follows the birthday rule for a child whose parents are married or living together: "The Health Plan of the parent whose birthday falls earlier in the calendar year is the Primary Health Plan" (same birthday: the plan covering that parent longest), unless a court decree says otherwise. 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. TRICARE is "last pay" (32 CFR 199.8).[6][2][3][4]
Ask the plan: Collect every coverage the child has, both parents' birthdays and any custody decree at intake; confirm primacy with CareSource and the other carrier.
Coverage decides whether CareSource Indiana Marketplace 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.
CareSource sets a numeric floor in its Marketplace reimbursement policy MP-PY-1636 (eff. 12/1/2025, Indiana included): "A supervising BCBA must be enrolled with the CareSource plan and meet the following minimum in-person observation thresholds for each BCaBA or RBT under supervision: 01. 5% of total ABA treatment hours performed by the BCaBA or RBT 02. 1 hour of ABA delivery performed by BCaBA or RBT every 30 days." When not observing, the BCBA "must be on- call and immediately available" (telecommunication suffices) and "must review and approve the data collection and progress notes" before any claim. MP-MM-1329 adds that BCaBA services "must be supervised by a BCBA, BCBA-D, or a licensed psychologist who tested in ABA and is certified by the American Board of Professional Psychology in Behavioral and Cognitive Psychology." In Indiana a direct-contact technician must also act "under the extended authority and direction of" an Indiana-licensed behavior analyst (IC 25-8.5-3-6).[5][8][13]
No per-day unit ceiling and no annual ABA benefit limit (EOC: "None"). Hours are set per member: "requested number of ABA hours per week based on the member's specific needs, not on a general program structure." Behavioral assessments "are not to exceed 8 hours every 6 months unless additional justification is provided," and caregiver coaching is authorized at up to 18 hours per 6-month period.[8][6]
MP-PY-1636 (eff. 12/1/2025) lists the minimum documentation for every service, including "start and stop times including any pauses in services," "type/code of service provided," "rendering provider’s name, credentials, and dated signature," the parent/guardian’s dated signature on treatment plans, and others present; the supervising BCBA "must review and approve the data collection and progress notes completed by a BCaBA or RBT under supervision prior to submitting a claim." MP-MM-1329 requires the treatment record to be submitted to CareSource before the claim. No deadline for signing a note is stated.[5][8]
No POS list is published. MP-MM-1329 excludes "any program or service performed in nonconventional settings, even if performed by a licensed provider," education services available under IDEA, and "services provided by a healthcare provider located in-state when an individual receiving ABA services is out of state." Treatment plans must include school transition plans and IEP/504 information to avoid duplicating school services.[8]
Blocked on: Ask CareSource Provider Services (1-833-230-2101) which POS codes it pays for ABA in home, clinic, community and school.
MP-MM-1329 excludes "concurrent, overlapping billing (eg, speech therapy, occupational therapy, physical therapy) occurring during the provision of ABA services" and services "provided simultaneously by more than 1 ABA provider, unless determined to be medically necessary, prior authorized and indicated in the approved behavior plan." The Marketplace reimbursement policy MP-PY-1636 does not address billing 97155 for the same clock time as 97153; it does say a BCBA delivering 1:1 treatment without supervising a technician bills it as treatment, not protocol modification.[8][5]
Ask the plan: CareSource Marketplace Provider Services, 1-833-230-2101: ask whether 97155 and 97153 may be billed for overlapping time when the BCBA directs the RBT in session.
Neither policy says whose NPI goes on technician time. MP-PY-1636 requires the supervising BCBA to be enrolled with CareSource, says "RBTs must use appropriate modifiers that indicate qualifications of staff delivering services, if applicable," allows an RBT to work under an independent practitioner only while both are affiliated with the same organization, and gives new RBTs 60 days from hire to complete BACB credentialing. MP-MM-1329 requires a BCaBA to be enrolled in the Marketplace program.[5][8]
Ask the plan: CareSource Marketplace Provider Services, 1-833-230-2101: ask whether RBT time bills under the supervising BCBA, the group, or the RBT’s own NPI, and which modifiers apply.
90 days from the date of service, unless your provider contract sets another limit; corrected claims are also due within 90 days of the date of service (CareSource notice IN-EXCP-0163, effective April 1, 2020, confirmed in its May 2025 Indiana orientation).
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.
Yes. The 2026 Indiana Marketplace EOC lists adaptive behavior treatment including ABA under Autism Spectrum Disorder Services with no benefit limit, subject to prior authorization and the deductible, copay and coinsurance in the member's Schedule of Benefits.
No. The Medicaid plan follows IHCP ABA rules and has its own guide. The Marketplace plan follows its own EOC, prior authorization list and policy MP-MM-1329, with its own network and cost sharing.
Under MP-MM-1329, a child and adolescent psychiatrist, clinical psychologist, child neurologist or developmental pediatrician, evaluating independently of the ABA provider. The request also needs the ASD level and the standardized tools used, such as ADOS, ADI-R or CARS-2.
Medical necessity is reviewed at baseline and every 6 months; the initial treatment plan generally runs 26 weeks and continuation requests are due every 6 months.
Yes, usually. The EOC applies the deductible, copayment and coinsurance from the Schedule of Benefits, no less favorable than for physical illness. Check deductible status before quoting.
Indiana requires an Indiana license (IC 25-8.5-3-6), and its telehealth law counts only Indiana-licensed behavior analysts as practitioners. We have not verified this plan’s own credentialing rule for out-of-state BCBAs; ask provider relations.
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.
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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