---
title: "Florida Blue ABA coverage: the intake guide."
url: "https://carelu.com/payers/florida-blue"
markdown_url: "https://carelu.com/payers/florida-blue.md"
state: FL (Florida)
payer: Florida Blue (Blue Cross and Blue Shield of Florida)
kind: Commercial insurance
description: "How Florida Blue covers ABA: Lucet authorizes it under medical policy 20.5.005, Florida Blue covers ABA without plan limits under the autism benefit, the Geller Act (§ 627.6686) sets the mandate floor, and BlueCard governs out-of-state members. Includes what intake should collect."
last_reviewed: October 2026
---

# Florida Blue ABA coverage: the intake guide.

_Payer Guide · Florida Blue · Florida · Last updated October 2026 · 13 primary sources_

> Florida's local Blue; ABA authorized by Lucet under policy 20.5.005, covered without plan limits per Florida Blue, plus the § 627.6686 mandate layer.

Florida Blue (Blue Cross and Blue Shield of Florida, with its HMO, Health Options) is Florida's local Blue plan, and it does not review ABA itself. "The management of behavioral health services for Florida Blue and Florida Blue HMO members, including Case Management, is delegated to Lucet Behavioral Health," formerly New Directions. In practice an ABA request is a Lucet request, reviewed against Lucet's ABA medical policy, sitting on a Florida Blue benefit and Florida's autism mandate.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required. Lucet reviews the ABA pre-treatment assessment as its own request: the member must have a DSM-based ASD diagnosis from a qualified clinician, and the hours requested must be no more than the assessment needs (Lucet policy 20.5.005). Florida Blue PPO and HMO requests go to Lucet by fax (816-237-2372, "Attn: FL ABA Request") or through WebPass. [1][2]
- **Prior auth for treatment**: Required. "Applied Behavior Analysis (ABA) requires authorization. Lucet will assign an authorization reference number." Florida Blue's manual says group BlueCare, BlueOptions and BlueChoice require authorization for autism-related therapy. Treatment plans are reviewed twice a year, and Lucet asks for reauthorization requests at least two weeks before the current authorization expires. [2][1][3]
- **Autism diagnosis required?**: Yes, ASD. Lucet's policy covers ABA for "members with the diagnosis of Autism Spectrum Disorder." The diagnosis must meet current DSM criteria and be backed by a comprehensive diagnostic evaluation with an ASD-specific standardized assessment. Screening results alone do not count. The Florida mandate also names Down syndrome for ABA on the group plans it reaches, so a Down syndrome request turns on the member's plan documents. [1][2][8]

## At a glance

- **Covers ABA?:** Yes, for ASD, reviewed by Lucet (policy 20.5.005). Florida Blue covers ABA "without limits" under the autism benefit
- **Prior auth:** Required for assessment and treatment. Fax Lucet 816-237-2372 ("Attn: FL ABA Request") or use WebPass
- **Claims:** Electronic, payer ID 00590. 180-day filing limit. Group NPI billing, individual NPI rendering
- **State mandate:** § 627.6686, Fla. Stat. (insurers) + § 641.31098 (HMOs), the Geller Act
- **Mandate age:** Under 18 (or 18+ still in high school), dx of a developmental disability by age 8
- **Mandate caps:** $36,000/yr; $200,000 lifetime (CPI-adjusted; parity-limited)
- **Exempt from mandate:** Individual, individually underwritten, and small-group plans; self-funded ERISA
- **Licensure:** None. No FL behavior analyst license; BCBA/FL-CBA credential (s. 393.17)

## Lucet runs the ABA benefit

Florida Blue delegates behavioral health, ABA included, to Lucet Behavioral Health. Florida Blue's coverage guideline 01-97000-08 no longer carries an ABA coverage statement: it was deleted on 01/01/2020, and the guideline now covers PT, OT and speech for autism comorbidities. The ABA criteria live in Lucet's medical policy 20.5.005. Florida Blue's manual lists ABA under the autism benefit: "Applied Behavior Analysis, when rendered by an individual certified per Section 393.17 of the Florida Statutes," and "ABA is covered without limits and authorizations are coordinated under the Mental and Nervous by Lucet Behavioral Health." [3][6][2][7]

Lucet's Florida Blue PPO and HMO appendices route ABA the same way. Authorizations are faxed to 816-237-2372 ("Attn: FL ABA Request"). Precertification questions go to 866-730-5006 or WebPass, benefits and eligibility to 866-287-9569, and claims inquiries to 877-801-1159. Lucet's general ABA rules apply on top. The authorization is issued in the BCBA's name, request forms are on WebPass, reviews "may take up to 15 days," and changes go on the ABA Amended Request form. "Some plans do not have a benefit for ABA services," so verify the benefit first. [3][6][2][7]

## What Lucet wants at intake and with the first authorization

For the pre-treatment assessment, Lucet requires a DSM-based ASD diagnosis from a qualified clinician. It must come with "a clinical note of sufficient depth that allows concordance with current DSM criteria," and "a complete diagnostic evaluation must be completed, including an ASD-specific standardized assessment" that rules out look-alike conditions. The hours requested must be no more than the assessment needs. [1][2]

The initial treatment request adds psychological testing with formal score reports: autism-specific, adaptive and cognitive. The baseline data must be "completed no longer than five (5) years prior to or scheduled within ninety (90) days of the pre-treatment assessment." It must include a developmental and cognitive evaluation, a severity-rating autism assessment, an adaptive behavior assessment "completed within 6 months of start date of treatment," and a neurological evaluation as part of a comprehensive physical exam. The treatment plan needs measurable goals on core ASD deficits with baselines, mastery criteria and generalization plans; caregiver-training goals; care coordination, safety and discharge planning; and a plan for transferring instructional control to caregivers. Continued authorization adds documented benefit, new or continuing goals, and a revised plan. [1][2]

## The Florida mandate: what it guarantees (and doesn't)

The Steven A. Geller Autism Coverage Act (2008) requires coverage in group plans issued or delivered in Florida after April 1, 2009. In practice that means fully insured large-group plans and the state employee plan under § 627.6686, with companion § 641.31098 reaching large-group HMO contracts. It explicitly excludes individual-market, individually underwritten and small-employer plans. The eligible individual is under 18 (or 18 and older but still in high school) and diagnosed with a developmental disability at 8 years of age or younger. Covered services include well-child ASD screening plus speech, OT, PT and applied behavior analysis, and the mandate covers Down syndrome as well as ASD. ABA benefits cap at $36,000 a year and $200,000 lifetime, adjusted each January 1 for medical CPI. ABA providers must be certified under s. 393.17, Fla. Stat. or licensed under chapters 490/491. Self-funded ERISA plans sit outside state reach. Because ASD treatment is treated as a mental health benefit, MHPAEA's ban on dollar limits arguably neutralizes the caps for parity-subject plans. Treat that as analysis, not settled guidance. Florida Blue's own manual goes further than the cap: it describes ABA under the autism benefit as covered without limits. [8][9][3]

## Claims, appeals and the Florida payment clock

Lucet's Florida Blue appendix: claims "must be filed within 180 days from the date of service," must be "submitted electronically using payer ID – 00590," and clean claims "will be processed within 10 to 30 days," with status on Availity. Practices billing under a tax ID need a type 2 (group) NPI for the billing provider and the individual NPI as rendering. Florida Blue's own manual restates the 180-day limit where Florida law applies. Lucet handles standard medical-necessity appeals within 30 calendar days (filed within 180 days of the denial). Expedited appeals are decided within 72 hours and go to Florida Blue at 877-842-9118. [2][4][11][12]

Florida law sets the payer's clock for fully insured plans. An electronic claim must be paid, denied or contested within 20 days, and every claim paid or denied within 90 days of receipt. Failure to do so within 120 days "creates an uncontestable obligation to pay the claim." Overdue payments bear 12% simple interest (§ 627.6131 for insurers, § 641.3155 for HMOs). Self-funded employer plans follow their plan documents and your contract instead. [2][4][11][12]

## BlueCard: out-of-state Blue members in Florida, and Florida Blue members out of state

Under BlueCard, claims go through the treating provider's local Blue plan. For a Florida practice treating another state's Blue member, that is Florida Blue. Its manual tells providers to select Florida Blue on Availity "under any circumstance where Florida Blue is adjudicating the claim. This includes BlueCard claims where Florida Blue is the host plan." Lucet's appendix routes "In-state and Out-of-state (BlueCard) claims review requests" through Availity. Benefits belong to the member's home plan. Florida Blue's manual gives an example: for a BlueCard member, "You must contact the home plan to determine" whether partial hospitalization is an inpatient or outpatient benefit. When the member's Blue plan is unknown, it points to BlueCard Eligibility at (800) 676-BLUE (2583). Lucet's manual adds that out-of-state ABA providers contracted with their local Blue under different codes are paid only for codes equivalent to the covered ABA codes. [5][4][2]

## Licensure & rates in Florida

Florida has no state behavior-analyst license and is absent from the BACB's list of states with licensure laws. The operative credential is BACB certification (BCBA, BCaBA or RBT). s. 393.17, Fla. Stat. recognizes BACB certification, legacy Florida Certified Behavior Analysts remain recognized, and the Geller Act keys ABA coverage to s. 393.17 certification or Chapter 490/491 licensure. Florida Blue's commercial ABA rates are not published. They are set in the Lucet participation agreement, and Lucet's portal carries a rate-increase request process. The Florida Medicaid schedule is the local benchmark: 97153 pays $12.26 per 15-minute unit. [10][8][7]

## Intake gates

The questions that decide whether a family can start with Florida Blue (Blue Cross and Blue Shield of Florida), and what they have to bring.

- **Diagnosis recency**: No expiry on the diagnosis itself, but Lucet puts clocks on the baseline data behind it. Lucet's policy says the developmental and cognitive evaluation, the autism-specific assessment that sets severity, and the neurological evaluation must be "completed no longer than five (5) years prior to or scheduled within ninety (90) days of the pre-treatment assessment." The adaptive behavior assessment must be "completed within 6 months of start date of treatment." Lucet's manual adds that one standardized adaptive instrument and one standardized cognitive instrument are "required within 90 days of pre-treatment assessment to establish baseline data." [1][2]
- **Who may diagnose**: "A clinician who is licensed and qualified to make such a diagnosis. Such clinicians are usually neurologists, developmental pediatricians, pediatricians, psychiatrists, licensed clinical psychologists or medical doctors experienced in the diagnosis of ASD. State law may define eligible qualified clinicians." The diagnosis must come with "a clinical note of sufficient depth that allows concordance with current DSM criteria." The comprehensive evaluation must rule out conditions that look similar, including neurological, hearing and behavior disorders and other developmental delays. [1]
- **Diagnostic tools required**: Lucet's manual names the instruments. One diagnostic assessment is "required to meet the diagnostic criteria outlined in the ABA Medical Policy": ADOS-2, ADI-R or a DSM-5 Checklist. One standardized adaptive instrument (Vineland, ABAS, BASC or PDDBI) and one standardized cognitive instrument (for example Bayley, Mullen, DAS, WPPSI or WISC) are required within 90 days of the pre-treatment assessment. Screeners such as the M-CHAT-R/F, CARS-2, GARS, SCQ or SRS-2 "are not appropriate standalone support for an autism diagnosis." Curriculum tools such as the VB-MAPP, ABLLS or AFLS are optional ways to show progress. [2][1]
- **Age limit** _(plan-dependent)_: Neither Florida Blue nor Lucet publishes an ABA age limit. Lucet's policy says comprehensive ABA "is primarily directed to children ages 3 to 8 years old," and focused ABA has no stated age range. Both describe a treatment model, not a benefit boundary. The age terms that apply come from the Geller Act, and only on the plans it reaches. An eligible individual is "under 18 years of age or 18 years of age or older who is in high school" and "diagnosed as having a developmental disability at 8 years of age or younger." Florida Blue quotes that definition in its own coverage guideline. The mandate binds fully insured large-group and state-employee plans. Individual, individually underwritten and small-employer plans are excluded by the statute, and self-funded ERISA plans are outside state reach. [1][6][8]
  - Ask the plan: The member's plan documents and a Lucet benefits check (866-287-9569): ask whether the plan carries an ABA age limit and whether it is fully insured large group.
- **Referral required?** _(plan-dependent)_: No referral or physician order is required for ABA under Lucet's policy for Florida. Lucet's only prescription requirement is in its Maryland addendum. Florida Blue's manual says BlueCare HMO members do not need a PCP referral to see a participating specialist. For myBlue (the individual-market HMO), "A referral for behavioral health services is not needed from the myBlue assigned PCP," but "The referral is not an authorization." The gate is Lucet's authorization, and the request needs the diagnostic evaluation behind it. Florida's mandate adds a physician order on the plans it reaches (fully insured large-group and state-employee plans, with § 641.31098 for HMOs). Coverage "shall be limited to treatment that is prescribed by the insured's treating physician in accordance with a treatment plan." That plan "shall include ... a diagnosis, the proposed treatment by type, the frequency and duration of treatment, the anticipated outcomes stated as goals, the frequency with which the treatment plan will be updated, and the signature of the treating physician" (§ 627.6686(4)(a), (7)). The statute names a physician, not a psychologist, and sets no validity period beyond the update frequency written into the plan itself. In practice the order is the treating physician's signature on the treatment plan itself. Individual, small-group and self-funded plans are outside the mandate, so for them the order is a plan-document question. [1][3][2][14]
  - Ask the plan: The member's plan documents and a Lucet benefits check (866-287-9569): ask whether the plan is subject to the Florida mandate (fully insured large group or state employee plan) and whether a signed physician prescription and treatment plan must be on file before Lucet will authorize treatment.
- **Telehealth** _(plan-dependent)_: Not set out for ABA. For Florida Blue members, Lucet's appendix says only that "Reimbursement for telehealth services is subject to plan guidelines." Lucet's manual says 97153, 97154, 97155 and 97158 require face-to-face services with the patient, and 97156 and 97157 with the guardians or caregivers present. It does not say whether face-to-face can be met by video. [2]
  - Ask the plan: Lucet benefits and eligibility (866-287-9569) or WebPass: ask whether the member's plan pays ABA codes by telehealth, which codes, and which modifier and place of service to use.
- **Prior-auth decision time** _(plan-dependent)_: Lucet: "Reviews of authorization requests may take up to 15 days," and reauthorization requests should go in "at least two weeks prior to authorization expiration." No Florida statute sets the decision deadline. § 627.42392, Fla. Stat. governs the prior authorization form, not the clock. The federal claims rule sets the floor for employer plans and for non-grandfathered individual and marketplace plans: a pre-service decision "not later than 15 days after receipt of the claim," with one 15-day extension, and urgent care "not later than 72 hours after receipt." Lucet decides expedited medical-necessity appeals within 72 hours and standard appeals within 30 calendar days. [2][15][16][17]
  - Ask the plan: Lucet precertification (866-730-5006): whether the clock starts at receipt or at a complete request, and the plan's urgent timeframe.
- **Other insurance (who pays first)** _(plan-dependent)_: For a child covered on both parents' group plans, Florida's COB statute sets the order: "The benefits of the policy or plan of the parent whose birthday, excluding year of birth, falls earlier in a year are determined before" the other parent's. For divorced or separated parents, the order is the custodial parent's plan, then the custodial parent's spouse's plan, then the non-custodial parent's, unless a court decree assigns health costs to one parent. The statute reaches group policies and group plans issued in Florida. A self-funded employer plan follows its own plan document. Medicaid pays last (Rule 59G-1.052). TRICARE "pays after all other health insurance, except for" Medicaid, and CHAMPVA "is always the secondary payer, except to Medicaid." Get Florida Blue's Lucet authorization even when a public program is secondary. [18][19][20][21]
  - Ask the plan: Ask the family for both parents' cards and birth dates, and ask the employer whether each plan is fully insured (Florida statute applies) or self-funded (the plan document applies).

## Delivery and billing rules

Coverage decides whether Florida Blue (Blue Cross and Blue Shield of Florida) 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**: No numeric ratio is published. Lucet's "Essential Components of ABA Treatment" require "Ongoing direction of technician," "Ongoing, frequent review and analysis of direct observational data," and training technicians, family members and other caregivers on revised protocols. Its policy says that, absent state law, line therapy is provided by an RBT, BCaBA, BCBA or BCBA-D. Lucet recommends caregiver training of one hour for the first 10 hours of direct therapy plus half an hour for each further 10 hours. Florida does not license behavior analysts. The mandate ties covered ABA to s. 393.17 certification or Chapter 490/491 licensure, and Florida Blue's manual covers ABA "when rendered by an individual certified per Section 393.17 of the Florida Statutes." [2][1][3][8]
- **Daily limits / MUEs**: No unit cap. Florida Blue's manual says that, for the autism benefit, "ABA is covered without limits and authorizations are coordinated under the Mental and Nervous by Lucet Behavioral Health." For large-group plans, "Therapy for Autism and Down Syndrome must continue to be covered even after outpatient therapy limits are met." The hours come from the authorization. Lucet's policy describes comprehensive ABA as "25 to 40 total hours of direct services weekly" and focused ABA as "typically ... 10 to 25 total hours." Lucet's Florida Blue appendix adds: "All services must be billed in whole units. Partial units will not be paid." [3][1][2]
- **Session-note signature**: Lucet's medical-record standard: entries must be dated with start and stop times or duration, "clearly identify the rendering provider and be authenticated (signed) by the individual providing the services with a professional degree ... and/or professional credentials." "Only handwritten signatures and eligible EMR signatures qualify." An electronic signature must carry a unique personal identifier and the author's name, credentials, date and timestamp, so "a typed signature that lacks the above-listed identifiers would not qualify." Each date of service needs its own entry. "A summary of services for multiple dates of service or multiple members is unacceptable." [2]
- **Bill as provider**: Group NPI as billing provider, individual NPI as rendering. Lucet's Florida Blue appendix: "The group/type 2 NPI number will be used as the “billing provider” on a claim," and "The individual NPI number will be used as the “rendering provider” on a claim." A practice billing under a tax ID must have a type 2 NPI. The authorization "must be in the name of the BCBA who will be performing the services (e.g., 97151, 97155, 97156, 97157, 97158) or overseeing the technicians performing the services (e.g., 97152, 97153, 97154)." Claims go electronically to payer ID 00590. [2]
- **Place of service** _(plan-dependent)_: Setting follows the clinical need. Lucet's policy requires treatment "in the setting and intensity that is appropriate for the member's clinical needs, determined by where target behaviors are occurring." Comprehensive ABA "should initially occur in a structured setting with 1:1 staffing and should advance to the least restrictive environment." "ABA treatment is not designed to primarily attain academic performance." Lucet's manual asks for documentation of treatment participants, procedures and setting. No ABA place-of-service code list is published for Florida Blue. [1][2]
  - Ask the plan: The member's plan documents (any educational-services exclusion) and Lucet: ask whether school-based or community hours are payable on that plan.
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not published. Neither Lucet's manual nor its ABA policy says whether 97155 and 97153 may both be billed for the same clock time. Lucet points to the ABA Coding Coalition for code usage. Out-of-state providers paid through BlueCard are reimbursed only for "service codes equivalent to the covered ABA service codes" on that list. [2]
  - Ask the plan: Lucet claims inquiries (877-801-1159) or your Lucet contract: ask whether 97155 pays alongside 97153 when the analyst directs the technician face to face.

## What intake should collect for Florida Blue (Blue Cross and Blue Shield of Florida)

- **Plan type and funding:** PPO/BlueOptions, BlueCare HMO, myBlue, or a self-funded group: it decides which rulebook and which mandate apply.
- **Member ID with prefix:** Florida Blue or an out-of-state Blue (BlueCard). The prefix routes eligibility, precertification and claims.
- **Diagnostic evaluation:** DSM-based ASD diagnosis, diagnosing clinician and credentials, the clinical note, and an ADOS-2, ADI-R or DSM-5 Checklist result.
- **Baseline testing dates:** Developmental/cognitive, autism-specific and neurological evaluation within five years (or scheduled within 90 days), and adaptive testing within six months of the treatment start.
- **Age and diagnosis-age history:** For mandate plans: under 18 (or in high school), with the developmental-disability diagnosis made by age 8.

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

## Common questions

### Does Florida Blue cover ABA therapy?

Yes, for autism spectrum disorder. Florida Blue delegates the review to Lucet Behavioral Health, which applies its ABA medical policy 20.5.005. Florida Blue's manual says ABA under the autism benefit is "covered without limits," with authorizations coordinated by Lucet. Confirm the member's plan carries the benefit; Lucet notes some plans do not.

### Who authorizes ABA for Florida Blue members?

Lucet. Fax requests to 816-237-2372 ("Attn: FL ABA Request") or use Lucet's WebPass portal. Call 866-730-5006 for precertification questions. Reviews can take up to 15 days, and reauthorizations should go in at least two weeks before the current one expires.

### What documents does Florida Blue (Lucet) need for an ABA authorization?

For the assessment: a DSM-based ASD diagnosis from a qualified clinician, with a clinical note and a complete diagnostic evaluation that includes an ASD-specific standardized assessment such as the ADOS-2, ADI-R or a DSM-5 Checklist. For treatment: formal score reports for autism-specific, adaptive and cognitive testing. Baseline evaluations must be within five years (or scheduled within 90 days of the assessment), adaptive testing within six months of the treatment start. Add a treatment plan with measurable goals, caregiver-training goals, and coordination, safety and discharge planning.

### Does Florida Blue need a referral for ABA?

No referral is required under Lucet's policy for Florida. BlueCare HMO members do not need a PCP referral to see a participating specialist, and myBlue members do not need one for behavioral health. Lucet's authorization is the gate.

### What is Florida Blue's timely filing limit for ABA?

180 days from the date of service, filed electronically to payer ID 00590 (Lucet's Florida Blue appendix). Clean claims are processed within 10 to 30 days.

### What does the Florida autism mandate require?

For covered group plans: screening, speech, OT, PT and ABA for eligible individuals, meaning under 18 (or 18+ in high school) and diagnosed with a developmental disability by age 8. ABA is capped at $36,000 a year and $200,000 lifetime (CPI-adjusted). It covers Down syndrome as well as ASD. Individual, small-group and self-funded plans sit outside it.

### How does BlueCard work with Florida Blue?

A Florida provider treating another state's Blue member files with Florida Blue as the host plan, and the member's home plan decides benefits and precertification. A Florida Blue member treated out of state is billed through that provider's local Blue, with Florida Blue (through Lucet) as the home plan for authorization.

## Primary sources

1. [Lucet Medical Policy 20.5.005 — Applied Behavior Analysis for the Treatment of Autism Spectrum Disorder (applies 1/1/2026–12/31/2026)](https://lucethealth.com/wp-content/uploads/2025/12/2026-Lucet-ABA-for-Treatment-of-ASD.pdf)
2. [Lucet — Managed Behavioral Health Provider & Facility Manual (July 2026), incl. Florida Blue PPO and HMO appendices](https://lucethealth.com/wp-content/uploads/2024/09/Provider-Manual-July2026.pdf)
3. [Florida Blue — Manual for Physicians and Providers: Provider Participation, Plans and Products, Utilization Management](https://files.guidewell.com/m/26745a10e23752cf/original/providers-provider-manual-01.pdf)
4. [Florida Blue — Manual for Physicians and Providers: Claim Submission, Billing Guidelines](https://files.guidewell.com/m/682cef22c888300d/original/providers-provider-manual-02.pdf)
5. [Florida Blue — Manual for Physicians and Providers: Care Review, Coordination of Benefits, Appeals and Grievances](https://files.guidewell.com/m/810cd58904247aa/original/providers-provider-manual-03.pdf)
6. [Florida Blue Medical Coverage Guideline 01-97000-08 — Treatment of Autism Spectrum Disorders (reviewed 04/24/25)](https://mcgs.bcbsfl.com/MCG?mcgId=01-97000-08&pv=false)
7. [Lucet — Florida Blue provider page (behavioral health network)](https://lucethealth.com/providers/plan/florida-blue/)
8. [Fla. Stat. § 627.6686 (2024)](https://www.flsenate.gov/Laws/statutes/2024/627.6686)
9. [FL Dept. of Financial Services — ASD coverage overview](https://www.myfloridacfo.com/division/consumers/consumerprotections/autism-spectrum-disorder)
10. [BACB — U.S. Licensure of Behavior Analysts (FL not listed)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
11. [Fla. Stat. § 627.6131 (2026) — Payment of claims (health insurers)](https://www.flsenate.gov/Laws/Statutes/2026/627.6131)
12. [Fla. Stat. § 641.3155 (2026) — Prompt payment of claims (HMOs)](https://www.flsenate.gov/Laws/Statutes/2026/641.3155)
13. [Florida Blue — Provider News: Bulletins and FAQs (index)](https://www.floridablue.com/providers/news/bulletins-and-faqs)
14. [Fla. Stat. § 627.6686 (2026) — Steven A. Geller Autism Coverage Act](https://www.flsenate.gov/Laws/Statutes/2026/627.6686)
15. [§ 627.42392, Fla. Stat. — Prior authorization (2026)](https://www.flsenate.gov/Laws/Statutes/2026/627.42392)
16. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
17. [45 CFR 147.136 — internal claims and appeals, group and individual coverage (eCFR)](https://www.ecfr.gov/current/title-45/section-147.136)
18. [§ 627.4235, Fla. Stat. — Coordination of benefits](https://www.flsenate.gov/Laws/Statutes/2025/627.4235)
19. [Rule 59G-1.052, F.A.C. — Third-Party Liability Requirements (AHCA)](https://ahca.myflorida.com/content/download/5929/file/59G_1052_TPL_Requirements.pdf?version=1)
20. [TRICARE — Using Other Health Insurance](https://www.tricare.mil/Plans/OHI)
21. [VA — CHAMPVA: Information for Outpatient Providers (IB 10-1587, updated 9/20/2023)](https://www.va.gov/COMMUNITYCARE/docs/pubfiles/factsheets/FactSheet_01-20.pdf)

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.