---
title: "Cigna / Evernorth ABA coverage in North Dakota: the intake guide."
url: "https://carelu.com/payers/cigna-north-dakota"
markdown_url: "https://carelu.com/payers/cigna-north-dakota.md"
state: ND (North Dakota)
payer: Cigna / Evernorth in North Dakota
kind: Commercial insurance
description: "How Cigna / Evernorth covers ABA for North Dakota families: national policy EN0499, no PA on assessments, the HealthPartners network contract in North Dakota, Bulletin 2018-1 (no autism statute), behavior-analyst licensure, and what intake should verify."
last_reviewed: October 2026
---

# Cigna / Evernorth ABA coverage in North Dakota: the intake guide.

_Payer Guide · Cigna · North Dakota · Last updated October 2026 · 17 primary sources_

> EN0499 + autism resource guide; in North Dakota Cigna’s behavioral network is contracted through HealthPartners; Bulletin 2018-1 layer.

For an intake team in North Dakota, a Cigna card means four layers: Evernorth’s national ABA policy EN0499 with the Cigna autism resource guide, the HealthPartners network arrangement that governs who is in network in North Dakota, North Dakota’s Bulletin 2018-1 (the state has no autism statute), and the plan’s funding type. Many Cigna members are on self-funded employer plans, so check funding first.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Not required for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed or a BCBA and the policy covers ABA (Cigna autism resource guide) [2]
- **Prior auth for treatment**: Required: the completed assessment and treatment plan go with the ABA prior authorization request; EN0499 sets the medical-necessity criteria [2][1]
- **Autism diagnosis required?**: Yes: ASD (F84.0–F84.9 except F84.2 Rett syndrome) under DSM-5-TR criteria, from an independently licensed professional; provisional or rule-out diagnoses do not count [1]

## At a glance

- **Covers ABA?:** Yes, for ASD, per national policy EN0499
- **Network in ND:** Providers must be contracted through HealthPartners to be in network for Cigna members (Evernorth guidelines)
- **State mandate:** No autism statute; ND Insurance Department Bulletin 2018-1 (July 10, 2018), applying federal parity
- **Mandate age:** None set; the bulletin carries no age limit (its ABA paragraph refers to children)
- **Mandate caps:** None set; autism benefits may not carry limits stricter than medical/surgical benefits
- **Exempt from mandate:** Self-funded ERISA employer plans (not regulated by the Insurance Department)
- **Licensure:** Yes: licensed behavior analyst / assistant under N.D.C.C. ch. 43-64 (Board of Integrative Health Care)
- **Fee schedule:** Not public — Exhibit A of your provider agreement; in ND, the HealthPartners contract

## The national policy, applied in North Dakota

Cigna, through Evernorth Behavioral Health, covers ABA under EN0499 (effective May 15, 2026). Per the autism resource guide, "Prior authorization is no longer required for assessment CPT codes 97151, 97152, or 0362T with a diagnosis of autism, as long as the provider is independently licensed or a Board Certified Behavior Analyst® (BCBA®) and the patient’s policy covers ABA services." Treatment needs prior authorization with the assessment and plan. A full-text check of EN0499 and the resource guide found no mention of North Dakota, so the national criteria apply. [1][2][3]

The network is the North Dakota twist. Evernorth’s Administrative Guidelines (September 2026) list a HealthPartners arrangement for "Minnesota, North Dakota, and Western Wisconsin": "Providers in Minnesota, North Dakota, and Western Wisconsin must be contracted through HealthPartners® to be considered in network for patients with Cigna Healthcare coverage or a HealthPartners ID card," with a note that "Some exceptions exist where the Provider Agreement supersedes the HealthPartners agreement." So a North Dakota ABA agency usually reaches Cigna members through a HealthPartners contract, not a direct Evernorth one. The guidelines also carry a North Dakota Regulatory Addendum (60 days’ notice before termination without cause, insolvency continuation of care) that does not apply to self-funded plans. [1][2][3]

## The North Dakota coverage rule: Bulletin 2018-1

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. [4][5][6]

## Licensure, out-of-state BCBAs and rates

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. [9][10][11][12][17]

## Claims operations in North Dakota

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. [6][7][2][3]

Cigna’s own claim rules for ABA: electronic claims use Evernorth payer ID 62308; on a paper CMS-1500, "List only a BCBA or other licensed provider in box 33"; and "Evernorth does not credential nonlicensed/noncertified staff. Services for these staff members must be billed under the supervising provider." Confirm with HealthPartners whether its contract changes where North Dakota claims go. [6][7][2][3]

Evernorth’s Behavioral Health Administrative Guidelines (September 2026) set the filing limit: "We will only consider claims submitted within 90 days of the date of service or as otherwise defined in your Provider Agreement," unless "Applicable state law provides for a longer timely filing limit." For a secondary claim the 90 days run from "the primary payer’s processing date as stated on an explanation of benefits [EOB] or explanation of payment [EOP]," Medicaid-primary claims get three years, and a timely claim returned for more information gets a new 90 days from the date of the request. The North Dakota Regulatory Addendum adds no claim rule. State addenda do not apply to self-funded plans. The guidelines publish no check-run or weekly cut-off schedule. [6][7][2][3]

## What is Cigna’s fee schedule for ABA?

Cigna publishes no ABA rate table. Evernorth’s Administrative Guidelines say the Provider Agreement’s terms "include the reimbursement rates applicable to covered services," and tell ABA providers to see "Exhibit A in your Provider Agreement" for the fee schedule and the list of reimbursable autism services; fee questions go to Evernorth Provider Services at 800.926.2273. Virtual services carry modifier 95, which Evernorth says "will not change the reimbursement." In North Dakota, where the network contract usually runs through HealthPartners, the applicable rates are in that contract. For a public benchmark, ND Medicaid’s August 2026 fee schedule pays 97153 at $10.81 per unit. [3][17]

## What a reauthorization must show

Evernorth’s EN0499 sets what a continued-treatment request must show: "current data" collected "within no more than 60 days prior to the start date of the continued treatment request, as well as collected within no more than 60 days prior to the date the authorization request is received," with collection dates, for every behavior and skill targeted; data showing "ongoing and sustained progress toward mastering the treatment goals"; measurable improvement on "a reliable, valid, and standardized assessment instrument completed no more than one year prior to the start date of the continued treatment request"; an account of barriers and plan changes where progress is not shown; and dated stakeholder (caregiver) training data. EN0499 does not require the data to be graphed. [1]

## Intake gates

The questions that decide whether a family can start with Cigna / Evernorth in North Dakota, and what they have to bring.

- **Diagnosis recency**: No expiry on the diagnosis, but the request needs "The date on which the diagnosis was most recently made," and "provisional," "rule out" and similar labels do not count. The clocks run on data: the assessment instrument completed "within 60 days prior to the start of treatment" and baseline data collected within 60 days before treatment. [1]
- **Who may diagnose**: A healthcare professional "licensed to practice independently and whose licensure board considers diagnostics" within scope, applying DSM-5-TR criteria. [1]
- **Diagnostic tools required**: No single instrument is mandated, but assessments must use current editions of standardized tools (the policy’s example: "must be the Vineland-3 vs. Vineland-II"), with results reported. [1]
- **Referral required?**: EN0499 requires no referral or prescription. Assessments 97151, 97152 and 0362T need no PA with an autism diagnosis when the provider is independently licensed or a BCBA. 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. [2][1][4]
- **Telehealth**: "All ABA CPT codes are covered telehealth services" (autism resource guide), and EN0499 allows "traditional in-person service delivery, telehealth, or a hybrid," chosen on clinical factors; the line-of-sight documentation requirement "does not apply to telehealth services." Evernorth bills virtual services with modifier 95. The clinician still needs a North Dakota license to treat a North Dakota child. [2][1][3][9]
- **Age limit** _(plan-dependent)_: EN0499 sets no age cap; it says access to focused intervention "should not be restricted by age, cognitive level, diagnosis, or co-occurring conditions." 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][4]
  - Ask the plan: Live benefits verification (or HealthPartners for North Dakota network members): establish insured vs. self-funded ERISA first.
- **Prior-auth decision time** _(plan-dependent)_: 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. Cigna/Evernorth publishes no North Dakota-specific ABA turnaround or reauthorization lead time. [7][13]
  - 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 Cigna/Evernorth expects.
- **Other insurance (who pays first)** _(plan-dependent)_: 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, Cigna/Evernorth 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). [8][14][15][16]
  - Ask the plan: Ask Cigna/Evernorth 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.

## Delivery and billing rules

Coverage decides whether Cigna / Evernorth in North Dakota 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**: Case supervision by a BCBA, a Licensed Behavior Analyst, or an independently licensed mental health clinician with documented ABA training, at "one to two hours per ten hours of direct treatment"; when direct treatment is 10 hours a week or less, a minimum of one to two hours per week. In North Dakota the supervising analyst must also hold a ch. 43-64 license. [1][9]
- **Concurrent billing (97153 + 97155)**: "Only one provider can bill for a unit of time, with the exception of CPT codes 97153, 97154, and 97155 (direct supervision when the BCBA/qualified health care provider directs the technician and both are face-to-face with the patient at the same time)." [2]
- **Daily limits / MUEs**: No per-day cap is published. All ABA codes are 15-minute units and "All ABA services must be billed with CPT codes 97151–97158, 0362T, and 0373T ONLY"; intensity must reflect severity, goals and response to treatment. [2][1]
- **Session-note signature**: Each service record must include, among other items, the "Name, credential (if applicable), and signature of ABA provider who rendered the service," with dates, times, location and who was present. [1]
- **Place of service**: When treatment is delivered across settings ("home, clinic, school, community setting, etc."), quantitative data must be "clearly identified separately by location/setting." "Services that are considered primarily educational or vocational in nature" are not covered. [1]
- **Bill as provider**: "Evernorth does not credential nonlicensed/noncertified staff. Services for these staff members must be billed under the supervising provider." On a CMS-1500, "List only a BCBA or other licensed provider in box 33"; electronic claims use payer ID 62308. [2]

## What intake should collect for Cigna / Evernorth in North Dakota

- **Plan funding type:** Insured in North Dakota (Bulletin 2018-1 applies) vs. self-funded ERISA (plan document governs).
- **Network contract:** Confirm the agency is in network through HealthPartners (or a direct Evernorth agreement that supersedes it).
- **Member ID + card photo:** Enough to run a live benefits verification.
- **Diagnosis report:** Diagnosing clinician’s name, credentials and licensure type, plus the date of the most recent diagnosis. Provisional or rule-out diagnoses don’t count.
- **Standardized assessment timing:** Instrument administered within 60 days before treatment starts.

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

## Common questions

### Does Cigna require graphs for ABA reassessments?

No. Evernorth’s EN0499 requires dated data collected within 60 days before both the requested start date and the request’s receipt, sustained progress, and a standardized assessment from the past year, but it does not require graphs.

### What are Cigna (Evernorth)’s claim filing deadlines for North Dakota ABA claims?

90 days from the date of service unless your provider agreement or a longer state limit applies; secondary claims get 90 days from the primary payer’s EOB/EOP date, and a claim returned for more information gets a new 90 days. No check-run schedule is published.

### Does Cigna cover ABA therapy in North Dakota?

Yes, under national policy EN0499 for autism. For insured North Dakota plans, Bulletin 2018-1 also bars excluding ABA as experimental. Self-funded employer plans follow their own documents.

### How do I get in network with Cigna for ABA in North Dakota?

Evernorth’s guidelines say providers in North Dakota must be contracted through HealthPartners to be in network for Cigna members, with some exceptions where a direct Evernorth agreement supersedes it.

### Does the Cigna ABA assessment need prior authorization?

No, for 97151, 97152 and 0362T with an autism diagnosis when the provider is independently licensed or a BCBA and the policy covers ABA. PA starts at treatment.

### Can ABA for Cigna members be done by telehealth?

Yes. Cigna says all ABA CPT codes are covered telehealth services, billed with modifier 95. The clinician must be licensed in North Dakota.

## Primary sources

1. [Evernorth EN0499 — Intensive Behavioral Interventions (eff. 5/15/2026)](https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/en_mm_0499_coveragepositioncriteria_intensive_behavioral_interventions.pdf)
2. [Cigna / Evernorth autism resource guide (March 2025)](https://static.cigna.com/assets/chcp/pdf/coveragePolicies/medical/autism-resource-guide.pdf)
3. [Evernorth Behavioral Health Administrative Guidelines (PCOMM-2026-191, September 2026; HealthPartners network arrangement and North Dakota regulatory addendum)](https://static.evernorth.com/assets/evernorth/provider/pdf/resourceLibrary/behavioral/ebh-provider-admin-guide.pdf)
4. [ND Insurance Department Bulletin 2018-1 — Coverage of Treatments for Autism Spectrum Disorder (July 10, 2018)](https://www.insurance.nd.gov/sites/www/files/documents/Bulletins/2018/20180711%20Bulletin%202018-1.pdf)
5. [ND Insurance Department — Insurance Commissioner Issues Bulletin Supporting Treatments for Autism Spectrum Disorder (July 11, 2018)](https://www.insurance.nd.gov/news/insurance-commissioner-issues-bulletin-supporting-treatments-autism-spectrum-disorder)
6. [N.D.C.C. ch. 26.1-36 — Accident and Health Insurance (26.1-36-09.15 telehealth; 26.1-36-10 coordination of benefits; 26.1-36-37.1 claim payment time limits)](https://ndlegis.gov/cencode/t26-1c36.pdf)
7. [N.D.C.C. ch. 26.1-36.12 — Prior Authorization for Health Insurance](https://ndlegis.gov/cencode/t26-1c36-12.pdf)
8. [N.D. Admin. Code ch. 45-08-01.2 — Coordination of Benefits Regulation](https://ndlegis.gov/api/acdata/pdf/45-08-01.2.pdf)
9. [N.D.C.C. ch. 43-64 — Behavior Analysts (license required from January 1, 2020; State Board of Integrative Health Care)](https://ndlegis.gov/cencode/t43c64.pdf)
10. [N.D. Admin. Code ch. 112-05-01 — Behavior Analysts (licensure, endorsement, exemptions; effective January 1, 2021)](https://ndlegis.gov/api/acdata/pdf/112-05-01.pdf)
11. [N.D.C.C. ch. 43-57 — State Board of Integrative Health Care](https://ndlegis.gov/cencode/t43c57.pdf)
12. [BACB — U.S. Licensure of Behavior Analysts (North Dakota: 2011, ND Board of Integrative Health Care)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
13. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
14. [ND Medicaid Billing and Policy Manual — Third Party Liability (updated January 2026)](https://www.hhs.nd.gov/sites/default/files/documents/medicaid-policies/third-party-liability-tpl.pdf)
15. [10 U.S.C. 1079(i)(1) — TRICARE pays after other coverage except Medicaid](https://www.govinfo.gov/content/pkg/USCODE-2023-title10/html/USCODE-2023-title10-subtitleA-partII-chap55-sec1079.htm)
16. [38 CFR 17.270 — CHAMPVA is the last payer](https://www.ecfr.gov/current/title-38/section-17.270)
17. [ND Medicaid Professional Services Fee Schedule (data updated as of August 1, 2026; Autism category lines)](https://www.hhs.nd.gov/sites/default/files/documents/rate-2026-august-professional-fee-schedule.xlsx)

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.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.