Coordinated Care of Washington is Centene’s Apple Health plan and one of the five managed care plans HCA lists. It also administers Apple Health Core Connections, the single statewide plan for children and young adults in foster care, adoption support and foster care alumni, who get both medical and behavioral health services, ABA included, through Coordinated Care. Its Washington ABA policy, WA.CP.BH.104 (last revised January 2026, effective March 1, 2026), was rewritten to align with chapter 182-531A WAC and HCA’s January 2026 billing guide.
Initial ABA is medically necessary when the member has "a comprehensive diagnostic evaluation and multidisciplinary clinical treatment plan completed by a Health Care Authority (HCA) recognized ABA Center of Excellence (COE)" that establishes functional impairment, an adverse effect on participation or safety, a confirmed ASD or other qualifying developmental/intellectual disability, a reasonable expectation of measurable improvement, and either failed less-intensive interventions or no equally effective, less costly alternative. The member also needs an ABA Assessment and Behavior Change Plan (HCA 13-400) completed by a lead behavioral analysis therapist, applicable to the next six months and correlated with the COE evaluation, and an ABA Level of Support Requirement form (HCA 12-411).[3]
Continuation requires an updated behavior assessment and an updated treatment plan "every six months (or less, as clinically appropriate)," documented coordination with school and other providers, data from multiple settings and informants, transition and discharge planning, and either documented progress or, where progress is limited, a revised plan that re-evaluates each goal, increases intensity or caregiver training, and considers other services or settings. The policy also covers the Early Childhood Intensive Behavioral Intervention Day Treatment Program when ordered by the COE, inpatient ABA when severe harmful behavior prevents discharge, and lists the same non-covered services as the WAC (camps, respite, primarily educational services, school-based or early intervention program services and others). For Medicaid members, "when state Medicaid coverage provisions conflict with the coverage provisions in this clinical policy, state Medicaid coverage provisions take precedence."[3]
At HCA’s February 2025 ABA session, Coordinated Care pointed providers to its "Become a Provider" page (JoinOurNetwork@coordinatedcarehealth.com), asked for updated rosters at WAProviderUpdates@coordinatedcarehealth.com, and named its Pre-Auth tool and required ABA Prior Authorization form. Provider and member services are at 1-877-644-4613; Apple Health Core Connections (foster care) members call 1-844-354-9876. As for every Apple Health plan, each LBA, LABA and CBT must be enrolled with HCA as a servicing provider and appear on the group’s roster before claims.[4][5][7]
Coordinated Care’s Apple Health provider manual (July 2026) asks providers to make "their best effort" to submit claims within 180 calendar days of the date of service or the primary plan’s EOP, but it "will honor original claims and encounters within three hundred sixty-five (365) calendar days from date of service and secondary claims within three hundred sixty-five (365) calendar days from primary date of payment." A rejected claim does not stop the clock: the received date is the date a clean claim enters the system and gets a claim number. Corrected claims, reconsiderations and disputes are due "within 24 months of the date of service" (30 months where coordination of benefits with another carrier is involved), marked as corrected through the portal, a clearinghouse or a red-and-white paper form. When Coordinated Care is secondary, it requires its own prior authorization only if none was obtained from the primary payer, and a primary denial for lack of authorization is denied here too. Payment: Coordinated Care adjudicates "95% of clean claims within thirty (30) calendar days of receipt" and "99% of clean claims within ninety (90) calendar days of receipt," citing 42 CFR 447.46 and WAC 284-170-421. No weekly payment cycle or submission cutoff is published.[1][2]
The questions that decide whether a family can start with Coordinated Care of Washington, and what they have to bring. Each maps onto something intake should ask on the first call.
WA.CP.BH.104 sets no age limit (its focused-ABA description is "not restricted by age"), consistent with the state rule. 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.[3][6]
No expiry on the COE evaluation is stated; the LBAT plan must "correlate with the COE’s diagnostic evaluation," and the assessment and plan are updated every six months.[3]
An HCA-recognized ABA Center of Excellence (WA.CP.BH.104). 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.[3][6]
WA.CP.BH.104 names no instrument beyond the COE evaluation and the HCA 13-400 baseline measures (curriculum-based measures, single-case studies or other accepted tools). The state COE rule: 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.[3][6]
Yes: the COE’s evaluation and plan are required, and the day treatment program must be "ordered by the COE." 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.[3][6]
WA.CP.BH.104 says telehealth is "not intended to replace in person service" and tells providers to "refer to respective state allowances for telehealth services." The state allowances: 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.[3][7][8]
Coordinated Care publishes no ABA decision timeframe in WA.CP.BH.104. Federal managed care rules apply: for rating periods starting on or after January 1, 2026, standard decisions "may not exceed 7 calendar days after receiving the request for service" (42 CFR 438.210(d)).[9][3]
Ask the plan: Coordinated Care Provider Services, 1-877-644-4613.
Not stated in WA.CP.BH.104. Medicaid is payer of last resort (42 CFR 433.139), and HCA’s ABA guide makes Apple Health PA unnecessary while an unexhausted private ABA benefit is paying.[10][7]
Blocked on: Coordinated Care provider manual (coordination of benefits section) or Provider Services, 1-877-644-4613.
Coverage decides whether Coordinated Care 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.
WA.CP.BH.104: "Supervision by a Lead Behavioral Analysis Therapist of care provided by a Certified Behavioral Therapist (CBT) should occur at a minimum of five percent of the total direct care per week (e.g., one hour of supervision per twenty hours of care)," and treatment must be "delivered or supervised by an ABA-credentialed professional."[3]
No unit cap in WA.CP.BH.104. Its background describes comprehensive ABA intensity as ranging "from 30-40 hours of treatment per week," individualized; hours are set per authorization.[3]
WA.CP.BH.104 notes services may be provided in home, clinic, school and community settings and by telehealth, and excludes "School-based health care services or early intervention program-based services under WAC 182-531A-0600"; services "in lieu of school, respite care, or other community-based settings of care" are a ground for discontinuation.[3]
Not stated in WA.CP.BH.104. The HCA rule binds all MCOs: Every LBA, LABA and CBT must hold a DOH credential, an NPI and an Apple Health enrollment as a servicing provider under a group’s core provider agreement, be on the roster the group sends each MCO, and have their own NPI in the servicing provider box on claims for dates of service on and after July 1, 2025 (HCA technical assistance, February 2025). HCA’s system "will deny/reject the claim if the servicing provider NPI has not been approved for enrollment." The only taxonomy for ABA is 103K00000X, entered in both the billing and servicing taxonomy fields. Claims must carry the authorization number, and dates, codes, modifiers and units must match the authorization.[4][7]
Not addressed in WA.CP.BH.104, which defers to the HCA billing guide; that guide bars 0373T simultaneously with 97153 or 97155 but does not settle 97153/97155 overlap.[3][12]
Ask the plan: Coordinated Care Provider Services, 1-877-644-4613, or your Provider Engagement Administrator.
WA.CP.BH.104 requires the treatment plan on HCA 13-400 by an LBAT but sets no session-note signature rule.[3]
Ask the plan: Coordinated Care provider manual (documentation standards) or Provider Services, 1-877-644-4613.
365 calendar days from the date of service for original claims, and 365 days from the primary payer’s payment for secondary claims (the manual asks for best effort within 180 days). Corrected claims and disputes: within 24 months of the date of service.
Yes, for Apple Health managed care members and for Apple Health Core Connections foster care members, under clinical policy WA.CP.BH.104 (effective March 1, 2026).
The COE’s comprehensive diagnostic evaluation and treatment plan, the LBAT’s HCA 13-400 assessment and behavior change plan, and the HCA 12-411 Level of Support form, on Coordinated Care’s ABA prior authorization form.
Continuation needs an updated assessment and treatment plan every six months, or sooner if clinically appropriate, with progress data from multiple settings.
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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