---
title: "Eastern Oregon CCO ABA coverage: the intake guide."
url: "https://carelu.com/payers/eastern-oregon-cco"
markdown_url: "https://carelu.com/payers/eastern-oregon-cco.md"
state: OR (Oregon)
payer: Eastern Oregon CCO (EOCCO)
kind: Medicaid managed care plan (MCO)
parent_program: Oregon Health Plan (Coordinated Care Organizations)
description: "How Eastern Oregon CCO covers ABA for OHP members in 12 eastern Oregon counties: prior authorization for every ABA code, GOBHI’s ABA program and its diagnosis, prescription and screening requirements, 7-day decisions and 120-day timely filing."
last_reviewed: October 2026
---

# Eastern Oregon CCO ABA coverage: the intake guide.

_Payer Guide · Eastern Oregon CCO · Last updated October 2026 · 17 primary sources_

> 12-county eastern Oregon CCO (Moda/GOBHI): every ABA code 97151–97158 on the September 2026 PA list; GOBHI runs an ABA program with a PCP-prescription front door.

Eastern Oregon Coordinated Care Organization (EOCCO) serves OHP members in Baker, Gilliam, Grant, Harney, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa and Wheeler counties. Moda Health administers the plan; Greater Oregon Behavioral Health, Inc. (GOBHI) handles behavioral health authorizations and runs an Applied Behavior Analysis program for children with autism.

This plan administers the **Oregon Health Plan (Coordinated Care Organizations)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Oregon Health Plan (Medicaid) guide](https://carelu.com/payers/oregon-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Yes: EOCCO’s Prior Authorization List (September 2026) lists 97151 through 97158 "Applied Behavior Analysis for Autism Spectrum Disorder" [3]
- **Prior auth for treatment**: Yes: the same list covers 97153–97158; behavioral health authorization requests go to GOBHI by fax (541-296-1036) or secure e-mail (um@gobhi.org) [3][4]
- **Autism diagnosis required?**: Yes: before services start, GOBHI’s ABA program needs a "Diagnosis from a medical professional (MD, FNP, Psychiatrist with experience in the diagnosis of ASD in children)" [2]

## At a glance

- **Covers ABA?:** Yes: GOBHI’s ABA program for children with ASD, under OHP rules
- **Service area:** 12 eastern Oregon counties
- **Prior auth:** All ABA codes, 97151–97158 (September 2026 list)
- **Front door:** Diagnosis (MD, FNP or psychiatrist), PCP prescription, well-child visits, hearing and vision screening
- **Decision clock:** 7 calendar days (plus up to 14)
- **Timely filing:** 120 days from the date of service

## GOBHI’s ABA program and the authorization path

EOCCO’s 2026 provider manual describes "GOBHI’s Applied Behavior Analysis (ABA) Program," which "offers comprehensive medically necessary ABA treatment services to children diagnosed with Autism Spectrum Disorder (ASD)," with parent coaching and 1:1 teaching. Before services start it requires: "1. Diagnosis from a medical professional (MD, FNP, Psychiatrist with experience in the diagnosis of ASD in children); 2. Primary Care Physician writes prescription for ABA therapy; and 3. Collect necessary documentation: well child visits, audio and vision screening, diagnosis paperwork." Referrals "can be made by any provider and/or individual" through gobhi.org/applied-behavior-analysis; GOBHI then reports waitlist placement or schedules the initial assessment. [2][3][4][5]

EOCCO’s Prior Authorization List (September 2026) includes 97151, 97152, 97153, 97154, 97155, 97156, 97157 and 97158. Behavioral health authorization requests go to GOBHI by fax to 541-296-1036 or secure e-mail to um@gobhi.org with the assessment, treatment plan and progress notes. EOCCO notifies providers of an approval, denial or need for information "within 7 calendar days of receipt of the request," with up to 14 more days when justified. Retroactive authorization requires the request "within ninety (90) days of the date of service." Claims must be received "within 120 days of the date of service," with listed exceptions. [2][3][4][5]

## Claim filing and payment rules for EOCCO

OHA’s managed-care billing rule binds every CCO, EOCCO included (OAR 410-141-3565, effective January 1, 2025). Initial claims are due "within no more than 120 days of the date of service," or within 365 days for pregnancy, retroactive eligibility, Medicare as primary payer, third-party liability and other delays not caused by the provider; a CCO "may negotiate terms within this timeframe," so your contract can set a shorter limit but not a longer one. For a timely claim that needs correction or resubmission, the CCO must allow "a minimum of 180 days after the initial adjudication date." Other insurance "must be exhausted prior to payment." On payment, CCOs "shall pay or deny at least 90 percent of valid claims within 30 days of receipt and at least 99 percent of valid claims within 90 days of receipt," make an initial determination on 99 percent within 60 days, and "may not require providers to delay claims submission." The rule sets no weekly payment cycle or submission cutoff. [1]

## Intake gates

The questions that decide whether a family can start with Eastern Oregon CCO (EOCCO), and what they have to bring.

- **Age limit**: GOBHI describes the program as serving children with ASD but states no age cut-off. OHP rules require ABA beyond Guideline Note 75 when medically appropriate "including individuals age 13 and older," and under 21 EPSDT bars age-group-wide denials. [2][8][16]
- **Diagnosis recency**: No recency rule for the diagnosis. GOBHI asks for well-child visit records and audio and vision screening; the OHP rule dates the physical exam (1 year for ages 1–6, 2 years for 6–18) and hearing test (1 year for 2–5, 2 years for 6–18). [2][8]
- **Who may diagnose**: An MD, FNP or psychiatrist "with experience in the diagnosis of ASD in children" (GOBHI). OHP’s rule lists a physician, psychologist, or developmental-medicine NP or PA (OAR 410-172-0770(1)). [2][8]
- **Diagnostic tools required**: EOCCO names no instrument, so the OHP rule applies: a standardized, validated tool such as the ADOS plus developmental status on assessments such as the Vineland (OAR 410-172-0770(1)(b), (g)). [2][8]
- **Referral required?**: Yes: the "Primary Care Physician writes prescription for ABA therapy." Referrals to the program can come from any provider or individual through gobhi.org. [2]
- **Telehealth**: EOCCO’s current documents publish no ABA telehealth rule of their own (its posted telemedicine overview dates from 2020). The state rule applies: "For purposes of behavioral health services, the Authority shall provide coverage for telemedicine services to the same extent that the services would be covered if they were provided in person" (OAR 410-172-0850(5)), using synchronous two-way video (telephone and e-mail only where HERC guidelines allow). OHA’s behavioral health fee schedule lists modifier GT ("Via Interactive Simultaneous Audio and Video Telecommunication Systems") as an allowable modifier on every ABA code it prices, 97151 through 97157, including the 97151 assessment and 97155 protocol modification. [2][10][11]
- **Prior-auth decision time**: EOCCO notifies providers of an approval, denial or need for more information "within 7 calendar days of receipt of the request," and may take 14 more calendar days with justification to OHA. [2][12]
- **Other insurance (who pays first)**: EOCCO’s manual adds only that it will seek a refund when a third-party carrier paid, so the state rule applies. Medicaid pays last. OHA must be "the payer of last resort," and "Providers shall make reasonable efforts to obtain payment first from other resources" (OAR 410-120-1280; 42 CFR 433.139). Bill the commercial plan first and follow its authorization rules. [2][15][18]

## Delivery and billing rules

Coverage decides whether Eastern Oregon CCO (EOCCO) 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**: EOCCO and GOBHI publish no ABA supervision ratio, so the state rule applies. OHA does not pay assistant behavior analysts or registered behavior analysis interventionists directly (OAR 410-172-0760(4)); they work under a directly payable Licensed Behavior Analyst, licensed health care professional or declarant. The licensing rule sets the interventionist supervision floor: direct and indirect supervision "for at least 5 percent of the interventionist’s service hours," including direct supervision at least once per calendar month, by a licensed behavior analyst, licensed assistant behavior analyst or licensed health care professional (OAR 824-040-0010). Direct supervision may be remote if it is synchronous audio and video (OAR 824-010-0005). [2][7][14]
- **Session-note signature**: EOCCO publishes no ABA session-note rule. The OHP floor applies: each note "signed or initialed by the individual providing the service" (OAR 410-172-0620(4)). [2][9]
- **Bill as provider**: EOCCO publishes no ABA rendering-provider rule; its BH authorization form asks for the provider’s billing NPI. The OHP rule applies: only a Licensed Behavior Analyst, licensed health care professional or declarant is eligible for direct payment (OAR 410-172-0760(3)–(4)). [4][7]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed in EOCCO’s provider manual or PA list. [2]
  - Ask the plan: GOBHI utilization management, 541-298-2101, or EOCCO provider services (888-788-9821).
- **Daily limits / MUEs** _(ask the plan)_: EOCCO publishes no ABA unit or hour limit. [2][3]
  - Ask the plan: GOBHI utilization management, 541-298-2101: ask how ABA units are authorized.
- **Place of service** _(ask the plan)_: EOCCO publishes no ABA setting rule. [2]
  - Ask the plan: GOBHI ABA program (gobhi.org/applied-behavior-analysis): ask which settings it serves and pays.

## What intake should collect for Eastern Oregon CCO (EOCCO)

- **Member ID:** Confirm EOCCO on the date of service.
- **Diagnosis:** From an MD, FNP or psychiatrist experienced in diagnosing ASD in children; also meet OAR 410-172-0770.
- **PCP prescription:** GOBHI requires the primary care physician to prescribe ABA.
- **Well-child, hearing and vision:** Well-child visit records plus audio and vision screening.
- **Other insurance:** Bill commercial coverage first; OHP is the payer of last resort.

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

## Common questions

### What is EOCCO’s timely filing limit for ABA claims?

120 days from the date of service under OAR 410-141-3565 (365 days for exceptions such as retroactive eligibility, Medicare or other insurance primary); your contract may set a shorter limit. Corrections and resubmissions get at least 180 days from the initial adjudication.

### Who provides ABA for Eastern Oregon CCO members?

GOBHI runs an ABA program for EOCCO children with autism; referrals go through gobhi.org/applied-behavior-analysis.

### Does EOCCO require prior authorization for ABA?

Yes. Its September 2026 Prior Authorization List includes every ABA code from 97151 to 97158.

### What does EOCCO need before ABA starts?

A diagnosis from an MD, FNP or psychiatrist experienced with ASD in children, a PCP prescription for ABA, well-child visit records, and audio and vision screening.

## Primary sources

1. [OAR 410-141-3565 — Managed Care Entity Billing (OHA, DMAP 143-2024, eff. 01/01/2025): §§ (1)(a)–(c), (6), (8)(b), (8)(d)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-141-3565)
2. [Eastern Oregon CCO — Provider Manual 2026 (incl. GOBHI Applied Behavior Analysis program)](https://www.eocco.com/-/media/EOCCO/PDFs/provider_manual.pdf)
3. [EOCCO Prior Authorization List — September 2026](https://www.eocco.com/-/media/EOCCO/PDFs/priorauth.pdf)
4. [EOCCO — Behavioral Health Authorization Form (GOBHI utilization management)](https://www.eocco.com/-/media/EOCCO/PDFs/providers/behavioral_auth.pdf)
5. [EOCCO — Referrals and authorizations (provider)](https://www.eocco.com/providers/referral-auths)
6. [OHA — Coordinated Care Organization (CCO) Plans (CCO list by county, read from the page’s CCO Plan Details list)](https://www.oregon.gov/oha/HSD/OHP/Pages/Plans.aspx)
7. [OAR 410-172-0760 — Applied Behavior Analysis (OHA, eff. 01/09/2025)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0760)
8. [OAR 410-172-0770 — Individual Eligibility for Applied Behavioral Analysis Treatment (OHA, DMAP 12-2017)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0770)
9. [OAR 410-172-0620 — Documentation Standards, Medicaid behavioral health (OHA, eff. 6/26/2015)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0620)
10. [OAR 410-172-0850 — Telemedicine for Behavioral Health (OHA, DMAP 67-2018)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-172-0850)
11. [OHA — OHP Fee-for-Service Behavioral Health Fee Schedule, Applied Behavior Analysis tab (update published 7/1/2026)](https://www.oregon.gov/oha/HSD/OHP/DataReportsDocs/bh-fee-schedule0726.xlsx)
12. [OAR 410-141-3835 — CCO Service Authorization (OHA, eff. 07/01/2026)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-141-3835)
13. [OAR 410-141-3565 — Managed Care Entity Billing (OHA, eff. 01/01/2025)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-141-3565)
14. [OAR 824-040-0010 — Training and Supervision of registered behavior analysis interventionists (eff. 2/1/2018)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=824-040-0010)
15. [OAR 410-120-1280 — Billing (third-party resources; OHA as payer of last resort)](https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-120-1280)
16. [OHA — EPSDT Provider Guide (March 2026)](https://www.oregon.gov/oha/HSD/OHP/Tools/EPSDT-Provider-Guide.pdf)
17. [EOCCO — News, Providers category (monthly provider newsletters and notices)](https://www.eocco.com/news?category=Providers)
18. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/api/renderer/v1/content/enhanced/current/title-42?part=433&section=433.139)

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.