Community Health Plan of Washington (CHPW) is one of the five Apple Health managed care plans HCA lists. It runs ABA under the state’s chapter 182-531A WAC pathway: a Center of Excellence evaluation and prescription, an LBAT assessment and plan, then CHPW prior authorization. Its 2026 behavioral prior-authorization list names ABA, and its ABA Initial Request Form lists exactly which documents to send.
CHPW’s 2026 Prior Authorization List and Utilization Guidelines for behavioral services (effective January 1, 2026) put "Applied Behavior Analysis (ABA) for Autism Spectrum Disorder" and "Treatment provided to members diagnosed with Autism Spectrum Disorder and other Developmental Disorders" under "PRIOR AUTHORIZATION REQUIRED." Requests go on the ABA Therapy Initial Request Form by fax to 206-613-8873; CHPW told providers at HCA’s February 2025 ABA session that its JIVA portal is "the preferred method." The form says the multidisciplinary plan is implemented "for a six-month period," and that providers in the authorization are limited to "State-approved ABA Center of Excellence teams and/or CHPW-credentialed ABA providers."[1][2][3][4]
Initial authorization requires the Center of Excellence evaluation with the ASD diagnosis, the COE’s recommendation for ABA, the ABA provider’s functional assessment, skill assessment or functional behavioral analysis, and the treatment plan. Recertification is "Submitted at least 3 weeks prior to expiration of current authorization" with a revised plan, measurable changes in the frequency, intensity and duration of targeted behaviors, the projected outcome, assessment instruments, developmental markers of readiness, evidence of coordination and of compliance with the plan; improvements must be confirmed with data, documented in charts or graphs, durable and generalized outside the treatment setting.[1][2][3][4]
CHPW requires a signed Apple Health core provider agreement and NPIs registered with HCA for every clinician. Licensed behavior analysts are credentialed (through CAQH or a Washington Practitioner Application to Provider.Credentialing@chpw.org); certified behavior technicians and licensed assistant behavior analysts are not individually credentialed but must be on the group’s roster, where they are loaded as "cred omitted." Re-credentialing is every three years. Claims go to Availity payer ID CHPWA (paper to CHPW Claims, PO Box 269002, Plano, TX 75026-9002) with taxonomy 103K00000X in both the billing and servicing fields. Timely filing: 12 months from the date of service as primary, 12 months from the primary payer’s remittance date as secondary, and 24 months for corrected claims; as secondary, CHPW "follows the primary payors denial/processing policies." Members can reach CHPW’s ABA line at 1-844-225-8624.[4][7]
CHPW’s provider manual could not be read this run (chpw.org returns a 403 to automated requests), so the state rules below are stated as Apple Health rules with "confirm with CHPW."[4][7]
The questions that decide whether a family can start with Community Health Plan of Washington, and what they have to bring. Each maps onto something intake should ask on the first call.
A state-approved ABA Center of Excellence; the form limits providers in the authorization to "State-approved ABA Center of Excellence teams and/or CHPW-credentialed ABA providers." A Center of Excellence: an individual provider, not a facility. Licensed under Title 18 RCW and experienced in diagnosing and treating ASD, a developmental pediatrician, neurologist, pediatric neurologist, pediatric psychiatrist, psychiatrist or psychologist qualifies whether or not they are on HCA’s COE list. ARNPs (including psychiatric mental health nurse practitioners), physicians, physician assistants and naturopaths qualify only after HCA’s COE training and designation, on a signed COE Attestation form HCA 13-0009 (WAC 182-531A-0800). HCA may, at its discretion, accept a non-COE evaluation, for example a recent evaluation paid by the child’s primary insurance. A COE serving an MCO member must also be contracted with that MCO.[2][6]
CHPW names no instrument. The state COE documentation rule applies: The COE documents "Results of formal diagnostic procedures performed by a provider, including name of measure, dates, and results, as available," or the clinical findings and observations used to confirm the diagnosis (WAC 182-531A-0500). The rule’s examples of ASD diagnostic tools are the ADI and the ADOS. If the COE has them, the evaluation must also include the ASD screening tool and date, a formal cognitive or developmental assessment with verbal, nonverbal and full-scale scores (examples: Mullen, Bayley, Wechsler) and a formal adaptive behavior assessment with domain scores (Vineland, ABAS), plus vision and hearing results.[2][6]
Yes: the COE’s "recommendation for ABA therapy" is a required initial document. Yes: a COE prescription. "Any person may refer a client" to a COE for an evaluation, including the PCP, a school or early intervention professional, the family or the MCO, though many COEs require a PCP referral and an MCO may require prior authorization for the COE evaluation. If the COE concludes ABA is appropriate it writes "a prescription for ABA services" and sends the evaluation and prescription to the chosen ABA provider or the family (WAC 182-531A-0500). The COE evaluation and order go in with the first PA request.[2][6][7]
CHPW is secondary to other coverage: a secondary claim is due within 12 months of the primary payer’s remittance date, and as secondary "CHPW follows the primary payors denial/processing policies." Medicaid is payer of last resort (42 CFR 433.139).[4][9]
CHPW publishes no ABA decision timeframe in the documents read. Federal managed care rules apply: for rating periods starting on or after January 1, 2026, standard authorization decisions "may not exceed 7 calendar days after receiving the request for service" (42 CFR 438.210(d)).[8][2]
Ask the plan: CHPW utilization management via JIVA or (800) 440-1561.
CHPW’s 2026 documents read state no age limit. The state rule sets none (No upper age limit. Chapter 182-531A WAC sets no age bound for ABA, and EPSDT (age 20 and younger) lets published limits be exceeded on medical necessity review. For a client first diagnosed at 21 or older, the COE who evaluates and orders ABA must be a psychiatric mental health nurse practitioner or a general practitioner designated by HCA as a COE, or a neurologist, psychiatrist or psychologist; ARNPs, physicians, PAs and naturopaths need additional COE training to prescribe ABA for adults.)[1][6]
Blocked on: CHPW customer service, (800) 440-1561: confirm CHPW applies no age limit to ABA for Apple Health members.
Not stated by CHPW. The state rule: the plan must correlate with the COE’s current evaluation, and requests are due within 60 days of the LBAT assessment.[2][6]
Ask the plan: CHPW utilization management: ask how old a COE evaluation may be for an initial request.
CHPW publishes no ABA telehealth rule in the documents read; its manual could not be opened. The state rule: HCA’s ABA billing guide (January 1, 2026) lists the ABA codes allowed by telemedicine. Allowed: 97155, 97156 and 97157, plus team conferences 99366 and 99368. Allowed with limits: 97151, but only for indirect work (caregiver interviews and rating scales, treatment plan development, record review, scoring); direct observation and direct assessment of the child may not be done remotely. In the day treatment program (H2020), direct ABA must be in person in the clinic, and CBT supervision may be by audio-visual telemedicine only while an LBAT stays on site. Not allowed by telemedicine: 0362T, 0373T, 97153, 97154 and 97158. For telemedicine the originating site is where the client is (where the caregiver is, for caregiver training). Bill POS 02, or POS 10 when the client is at home, and add modifier 95 when the distant site is a nonfacility; to bill for a client located in Washington the practitioner must be licensed in Washington or hold a compact license Washington recognizes, and no behavior analyst compact is on HCA’s list.[7][11]
Blocked on: CHPW customer service, (800) 440-1561: confirm CHPW follows HCA’s ABA telemedicine code list.
Coverage decides whether Community Health Plan of Washington 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.
The rendering clinician’s NPI. CHPW requires taxonomy 103K00000X "in both the billing and the servicing taxonomy fields," every clinician’s NPI registered with HCA, and all ABA staff on the roster; HCA requires the LBA, LABA or CBT who performed the service in the servicing provider box for dates of service from July 1, 2025.[4][7]
CHPW publishes no ABA supervision ratio in the documents read; its provider manual could not be opened. The state rule: The lead behavior analysis therapist (LBAT) must "Supervise a minimum of five percent of the total direct care per week provided by the CBT (e.g., one hour of supervision per twenty hours of care)," and a CBT must be "supervised directly by an LBAT for at least five percent of total direct care per week" (WAC 182-531A-0700) and review the client’s progress with the LBAT at least every two weeks. When a LABA fills the LBAT role, the LABA and the supervising LBA or licensed psychologist share those duties. DOH’s licensing rule layers on top: at least two face-to-face contacts a month with each CBT and direct supervision and observation of at least five percent of the CBT’s monthly hours, seeing the CBT with each client at least once every three months (WAC 246-805-330).[2][7][6]
Blocked on: CHPW Provider Relations or customer service, (800) 440-1561: confirm CHPW applies the Apple Health 5 percent LBAT supervision floor.
Not addressed in CHPW’s ABA documents read, and the state guide does not settle 97153/97155 overlap either.[2][7]
Ask the plan: CHPW customer service, (800) 440-1561, or your CHPW provider agreement.
CHPW publishes no ABA unit limits in the documents read; units are set per six-month authorization.[2]
Ask the plan: CHPW utilization management via JIVA or (800) 440-1561: ask whether HCA’s fee-schedule limits (97151 28 units per assessment, 2 a year) apply.
Not stated in CHPW’s ABA documents read.[2]
Blocked on: CHPW provider manual (chpw.org Provider Center) or Provider Relations.
Not stated by CHPW in the documents read. The state rule: Home, center, community (a school, daycare, inpatient unit or playground, for example) or an HCA-approved day treatment program, or a mix. Services in community settings such as a school or restaurant "must be included in the ABA therapy treatment plan" (WAC 182-531A-0600). Not covered unless prior authorized: "School-based health care services or early intervention program-based services" (WAC 182-531A-1000). Inpatient ABA is limited to short-term, focused treatment of severe harmful behavior that is preventing discharge, ordered by a COE. The day treatment program (H2020) is typically authorized once in a lifetime for 48 service days.[2][6]
Blocked on: CHPW customer service, (800) 440-1561: confirm which settings and POS codes CHPW pays for ABA.
Yes. ABA is on CHPW’s 2026 behavioral prior-authorization list. Fax the ABA Therapy Initial Request Form to 206-613-8873 or use the JIVA portal, with the COE evaluation, the COE recommendation, the assessment and the treatment plan.
No. CHPW credentials licensed behavior analysts; CBTs and LABAs go on the group roster and are loaded as "cred omitted." All of them need an NPI registered with HCA.
12 months from the date of service when CHPW is primary, 12 months from the primary payer’s remittance date when secondary, and 24 months for corrected claims.
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.
Carelu collects all of this automatically.
Every ID, document, and detail this payer requires — gathered conversationally the moment a family reaches out, with insurance verified before your team touches the file.
Get a Demo