---
title: "HealthPartners Medical Assistance ABA / EIDBI coverage: the intake guide."
url: "https://carelu.com/payers/healthpartners-minnesota"
markdown_url: "https://carelu.com/payers/healthpartners-minnesota.md"
state: MN (Minnesota)
payer: "HealthPartners — Minnesota Health Care Programs"
kind: Medicaid managed care plan (MCO)
parent_program: Minnesota Medical Assistance (EIDBI benefit, managed care)
description: "How HealthPartners covers ABA for Minnesota Health Care Programs members under the EIDBI benefit: its EIDBI coverage policy, which codes need prior authorization, the claim loops it requires, and what intake should collect."
last_reviewed: October 2026
---

# HealthPartners Medical Assistance ABA / EIDBI coverage: the intake guide.

_Payer Guide · HealthPartners · Minnesota · Last updated October 2026 · 13 primary sources_

> HealthPartners MHCP: EIDBI policy mirrors DHS criteria; PA by fax with the CMDE; claims need rendering and QSP loops.

HealthPartners publishes a dedicated EIDBI coverage policy for its Minnesota Health Care Programs members (revised October 6, 2026). It restates DHS’s eligibility, medical-necessity, reauthorization and termination criteria nearly word for word and lists the codes that need prior authorization. Its provider FAQ covers contracting, credentialing and billing.

This plan administers the **Minnesota Medical Assistance (EIDBI benefit, managed care)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [Minnesota Medical Assistance (EIDBI) guide](https://carelu.com/payers/minnesota-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: No for 97151 per HealthPartners’ EIDBI policy, whose prior-authorization code list covers 0373T and 97153–97157 only; the FAQ asks for the CMDE as the document for authorization review [1][2]
- **Prior auth for treatment**: Yes: "Prior authorization is required" for 0373T, 97153, 97154, 97155, 97156 and 97157, reviewed by the Behavioral Health Utilization Management team; fax clinical information to 952-853-8830 [1][2]
- **Autism diagnosis required?**: Yes: "Has autism spectrum disorder or a related condition," with a CMDE establishing medical need; a child under five "may not have an ASD or related condition diagnosis but may still meet medical necessity criteria" [1]

## At a glance

- **Covers ABA?:** Yes, as EIDBI for members under 21
- **Prior auth:** 0373T, 97153–97157; fax 952-853-8830 (BH UM 952-883-7501)
- **Decision clock:** FAQ says 14 days; Minnesota law since 1/1/2026 says 5 business days
- **Hours framework:** DHS impact-score table: 10–40 hours to age 7, 10–20 hours from 7 to 21
- **Claims:** Electronic only; rendering (2310B/2420A) and QSP supervising (2310D/2420D) loops required
- **Other insurance:** Bill HealthPartners directly; it pays EIDBI without a primary EOB

## Coverage and prior authorization

HealthPartners’ policy covers EIDBI when the member has ASD or a related condition, has had a CMDE establishing medical need, is under 21, and meets DHS’s medical-necessity criteria (including "10 or more hours per week of EIDBI services (unless there is a clinical rationale for an exception)"). It reprints DHS’s treatment framework by age and impact score: 10 to 40 hours a week through age seven, 10 to 20 hours from seven to 21, with DHS’s exceptions for fewer than 10 or more than 20 hours. "Prior authorization is required" for 0373T, 97153, 97154, 97155, 97156 and 97157. Requests go by fax to 952-853-8830; the FAQ lists the CMDE as the required document and says "HealthPartners has 14 days to make a decision about a request." That figure predates Minnesota’s 2026 change: § 62M.05 now gives utilization reviewers five business days for a standard decision and applies to Medical Assistance managed care from January 1, 2026. [1][2][9][8]

Non-covered services track DHS’s list: services by a parent or legal guardian, by someone without the qualifications, without the required supervision, while the child sleeps, that replace IEP academic goals, or that are not delivered to a person present in person or by interactive video (with exceptions for care conferences, family training, and CMDE or ITP work). [1][2][9][8]

## Billing HealthPartners for EIDBI

HealthPartners requires electronic claims and tells providers to bill "following the guidelines in DHS’s EIDBI billing grid." Its billing tips add that claims "must include both the rendering provider and Qualified Supervising Professional (QSP) on all claims for services where a QSP is required": rendering provider in loop 2310B, supervising provider in 2310D, and the line-level 2420A and 2420D loops when several staff bill on one claim. The UB modifier is required, units follow the midpoint rule, and date ranges must not include days with no service. For members with other coverage, "HealthPartners will process and pay their EIDBI Medicaid claims without you having to submit it to the primary insurer first"; if a claim denies for coordination of benefits, call claims customer service to have it reprocessed. Before credentialing, individual practitioners must be enrolled with DHS and the agency must hold or be offered a HealthPartners contract. [2][3]

## Claim filing and payment rules

HealthPartners’ claims chapter of its 2026 Provider Resource Manual (reviewed March 2026) leaves the filing deadline to the contract: contracted providers "must submit all claims for services, other than claims pended for coordination of benefits," within "a specified period of the date of service" set in the provider contract. Claims needing coordination of benefits "shall be submitted within sixty (60) days of determining HPI’s or its Affiliates’ obligation to make payment," and a timely-filing denial may be appealed within 60 days of the remit date. Corrected claims go electronically as bill frequency 7. On payment, the manual restates Minnesota’s rule that clean claims be paid or denied "within 30 calendar days after the date upon which the claim was received," with interest on late clean claims, and counts the paid date as the check date plus 3 days for mailing. No check-run schedule is published. For Medical Assistance members DHS’s managed-care contract standard is six months from the date of service (Minn. Stat. § 256B.69, subd. 5a). [12][14]

## Intake gates

The questions that decide whether a family can start with HealthPartners — Minnesota Health Care Programs, and what they have to bring.

- **Age limit**: "Is under age 21," per HealthPartners’ EIDBI policy. [1]
- **Diagnosis recency**: HealthPartners’ policy: to restart services "If the person’s CMDE is more than 36 months old (i.e., three years), the person must receive a new CMDE." Reauthorization requires continued medical necessity documented in the CMDE and ITP progress monitoring. [1]
- **Who may diagnose**: HealthPartners’ policy does not name diagnosers; it adopts DHS criteria. Set by statute: the diagnosis of ASD or a related condition must be "completed by either (i) a licensed physician, advanced practice registered nurse, or physician assistant, or (ii) a mental health professional," be based on current DSM criteria with direct observation and caregiver information, and meet the standard diagnostic assessment rules of § 245I.10, subd. 6 (§ 256B.0949, subd. 4). DHS’s eligibility page says assessors use the DC:0-5 for children five and younger and the DSM from age six. The CMDE provider (physician, APRN, PA, mental health professional, or qualified clinical trainee with 2,000 hours of ASD experience or equivalent coursework) then confirms medical necessity. [1][5]
- **Diagnostic tools required**: HealthPartners names no instrument. No instrument is mandated for EIDBI itself: DHS "strongly encourages providers to use standardized assessment tools" but "does not require specific assessment tools." The exception is a CMDE submitted for other disability or benefit decisions (waiver enrollment, SSI): there DHS requires "A direct observational assessment (e.g., ADOS-2)" and "A structured caregiver interview (e.g., ADI-R)," and says developmental history or non-autism-specific screens alone are "insufficient." [1][16][17]
- **Referral required?**: No referral is mentioned; HealthPartners requires prior authorization of treatment codes, and out-of-network providers need authorization for all services (DHS grid). [1][4]
- **Telehealth**: HealthPartners covers services delivered to a person present "either physically or via interactive video" and publishes no separate EIDBI telehealth rule. Yes, for most EIDBI services. The statute says Medical Assistance "covers medically necessary EIDBI services and consultations delivered via telehealth … in the same manner as if the service or consultation was delivered in person" (§ 256B.0949, subd. 13(l)). DHS lists the CMDE (97151), coordinated care conference, family/caregiver training (97156/97157), ITP development and progress monitoring (H0032), individual and group intervention (97153/97154) and observation and direction (97155) as telehealth-eligible; higher-intensity intervention (0373T) "cannot occur via telehealth." Same thresholds, authorization and rates as in person; QSP observation and direction may be remote for at most two consecutive months. Bill POS 02 (not at home) or POS 10 (at home), modifier 93 for audio-only, and never use telehealth POS or modifiers for non-client-facing services. Providers enroll for telehealth on the Telehealth Provider Assurance Statement (DHS-6806). [1][5][18]
- **Other insurance (who pays first)**: For EIDBI, "HealthPartners will process and pay their EIDBI Medicaid claims without you having to submit it to the primary insurer first"; a COB denial is reprocessed through claims customer service. This follows DHS’s pay-and-chase rule for managed care members. [3][19]
- **Prior-auth decision time** _(plan-dependent)_: HealthPartners’ FAQ: "HealthPartners has 14 days to make a decision about a request." Minnesota law since January 1, 2026 requires standard determinations within five business days of a complete request and expedited ones within 48 hours (§§ 62M.01, subd. 3(b), 62M.05), and federal rules cap standard decisions at 7 calendar days for rating periods from January 1, 2026 (42 CFR 438.210(d)). [2][8][9][10]
  - Ask the plan: HealthPartners BH UM, 952-883-7501: ask which clock it applies to EIDBI requests in 2026.

## Delivery and billing rules

Coverage decides whether HealthPartners — Minnesota Health Care Programs 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**: HealthPartners excludes services "Provided without the required supervision" and requires the QSP on supervised claims; the supervision floor is the statute’s. Set by statute for every Medical Assistance member, fee-for-service or managed care. An EIDBI agency must "provide clinical supervision for a minimum of one hour for every 16 hours of direct treatment per person, unless otherwise authorized in the person’s individual treatment plan," and must provide "the required EIDBI intervention observation and direction by a QSP at least once per month" (Minn. Stat. § 256B.0949, subd. 16(a)(15)–(16), as amended by Laws 2026, ch. 95). The QSP may do that monthly observation and direction by telehealth for no more than two consecutive months; the third month must be in person. DHS’s clinical supervision page (updated 9/15/26) adds that each person gets one primary QSP (who signs the ITP), a backup QSP must be available, and a different ratio needs an exception documented in the ITP and approved through service authorization. Every intervention must be "provided by a qualified EIDBI provider and supervised by a QSP" (subd. 13(a)). [1][3][5][6]
- **Daily limits / MUEs**: HealthPartners points to the grid’s limits: "Claims that do not adhere to these standards cannot be paid." Grid daily limits: 97153 and 0373T 8 hours, 97154 4.5 hours, 97155 6 hours, 97156/97157 4 hours; 97151 80 units a calendar year. Hours framework: up to 40 a week through age seven and up to 20 from seven, absent an exception. [3][7][1]
- **Session-note signature**: HealthPartners excludes services "Not documented in the person’s health service record or ITP." Statutory since 2026. New subdivision 19 of § 256B.0949 (Laws 2026, ch. 95, art. 4, sec. 26) requires all CMDE and EIDBI documentation to be "signed and dated by the provider completing the documentation with the provider’s full name, title, and credentials," to "be entered within 72 hours of service and contain a record and explanation of any delays in entry," and to "include a record of supervision and oversight for staff providing services requiring supervision." "Each EIDBI service occurrence must be documented in a progress note." DHS-7108 (CMDE) must be signed by the CMDE provider and the caregiver or guardian, and DHS-7109 (ITP) by the QSP and the caregiver or guardian; those signatures are the family’s consent to start or continue services. [1][6]
- **Bill as provider**: Both providers on the claim: rendering provider in loop 2310B (line 2420A when it differs) and the QSP as supervising provider in 2310D (line 2420D), "on all claims for services where a QSP is required." [3]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: HealthPartners tells providers to follow DHS’s billing grid and to identify each line’s rendering and supervising provider, but states no rule on billing 97153 and 97155 for the same time. DHS allows it when medically necessary. [3][15]
  - Ask the plan: HealthPartners BH UM, 952-883-7501 or 866-669-3856: ask whether simultaneous 97153 and 97155 lines by different providers are paid.
- **Place of service** _(ask the plan)_: HealthPartners publishes no setting list; it excludes services that replace IEP or IFSP academic goals and those not delivered to a person who is present in person or by interactive video. DHS settings (center, clinic, office, home or community) apply through the grid. [1][15]
  - Ask the plan: HealthPartners provider services or BH UM, 952-883-7501: confirm accepted POS codes for EIDBI.

## What intake should collect for HealthPartners — Minnesota Health Care Programs

- **Member ID:** Confirm HealthPartners Minnesota Health Care Programs coverage with the guest eligibility tool.
- **CMDE:** HealthPartners lists the CMDE as the required document for authorization review.
- **Supervising QSP:** The QSP’s NPI goes on every claim line that needs supervision.
- **Other insurance:** Record it; HealthPartners pays EIDBI without a primary EOB.

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

## Common questions

### What is HealthPartners’ timely filing limit for EIDBI claims?

The provider contract sets it (DHS requires MCOs to use a six-month standard for Medical Assistance). Coordination-of-benefits claims are due within 60 days of the point HealthPartners’ payment obligation is determined, and clean claims are paid or denied within 30 calendar days.

### Does HealthPartners require prior authorization for EIDBI?

Yes for 0373T and 97153–97157. Fax the clinical information, including the CMDE, to 952-853-8830.

### Whose NPI goes on a HealthPartners EIDBI claim?

Both: the rendering provider (loop 2310B/2420A) and the QSP as supervising provider (2310D/2420D) on every service that needs QSP supervision.

### Do I need the primary insurance EOB first?

No. HealthPartners pays EIDBI claims without billing the primary insurer first, following DHS’s pay-and-chase policy.

## Primary sources

1. [HealthPartners coverage policy — Early intensive developmental and behavioral intervention (EIDBI), Minnesota Health Care Programs (revised 10/06/2026)](https://www.healthpartners.com/public/coverage-criteria/policy.html?contentid=ENTRY_266466)
2. [HealthPartners — EIDBI provider FAQ (authorization, billing)](https://www.healthpartners.com/provider-public/eidbi/)
3. [HealthPartners — Helpful tips for billing HealthPartners for EIDBI services](https://www.healthpartners.com/content/dam/plan/providers/reference/helpful-tips-for-billing-healthpartners-for-eidbi-services.pdf)
4. [DHS — EIDBI Managed Care Organization (MCO) Contact Information Grid (October 2026)](https://www.dhs.state.mn.us/main/groups/manuals/documents/pub/DHS-312255.pdf)
5. [Minn. Stat. § 256B.0949 — Early Intensive Developmental and Behavioral Intervention (EIDBI) benefit](https://www.revisor.mn.gov/statutes/cite/256B.0949)
6. [Laws 2026, ch. 95, art. 4, secs. 23–26 — EIDBI definitions, QSP observation and direction, new documentation subdivision 19](https://www.revisor.mn.gov/laws/2026/0/Session+Law/Chapter/95/)
7. [DHS — EIDBI billing grid (August 2026)](https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_FILE&RevisionSelectionMethod=LatestReleased&Rendition=Primary&allowInterrupt=1&noSaveAs=1&dDocName=DHS16_195657)
8. [Minn. Stat. § 62M.01 — Utilization Review Act scope (applies to MA managed care and, for listed sections, MA fee-for-service from Jan. 1, 2026)](https://www.revisor.mn.gov/statutes/cite/62M.01)
9. [Minn. Stat. § 62M.05 — Review determinations: standard 5 business days, expedited 48 hours](https://www.revisor.mn.gov/statutes/cite/62M.05)
10. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
11. [42 CFR 433.139 — Medicaid third-party liability, incl. pay-and-recover for EPSDT (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
12. [HealthPartners — 2026 Provider Resource Manual: claims information (3/12/2026; timely filing, COB, prompt payment of clean claims)](https://www.healthpartners.com/content/dam/plan/providers/reference/claims-information.pdf)
13. [HealthPartners — Fast Facts newsletters (bi-monthly provider newsletter)](https://www.healthpartners.com/providers/provider-resources/fast-facts/)
14. [Minn. Stat. § 256B.69 — Prepaid health plans (subd. 5a managed care contracts, six-month timely filing standard)](https://www.revisor.mn.gov/statutes/cite/256B.69)
15. [EIDBI Benefit Policy Manual — EIDBI services (updated 1/6/26)](https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_195211)
16. [EIDBI Benefit Policy Manual — Eligibility for EIDBI services](https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_195213)
17. [EIDBI Benefit Policy Manual — Comprehensive multi-disciplinary evaluation (CMDE) (updated 11/7/25)](https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=dhs16_195210)
18. [EIDBI Benefit Policy Manual — Telehealth services (updated 9/10/26)](https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=DHS-292812)
19. [MHCP Provider Manual — Early Intensive Developmental and Behavioral Intervention (EIDBI) Benefit (revised Sept. 14, 2026)](https://www.dhs.state.mn.us/main/idcplg?IdcService=GET_DYNAMIC_CONVERSION&RevisionSelectionMethod=LatestReleased&dDocName=DHS16_195658)

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.