---
title: Humana Healthy Horizons in Oklahoma ABA coverage (SoonerSelect).
url: "https://carelu.com/payers/humana-healthy-horizons-oklahoma"
markdown_url: "https://carelu.com/payers/humana-healthy-horizons-oklahoma.md"
state: OK (Oklahoma)
payer: Humana Healthy Horizons in Oklahoma
kind: Medicaid managed care plan (MCO)
parent_program: Oklahoma Medicaid (SoonerCare / SoonerSelect) - Oklahoma Health Care Authority
description: "How Humana Healthy Horizons in Oklahoma administers the SoonerCare ABA benefit: its Oklahoma ABA policy (HUM-OK-2663-000) built on OHCA Part 30, PA on 97151/97153/97155/97156, the 24-unit assessment and 97151-TS reassessment limits, 10% case supervision from October 2026, and its decision clocks."
last_reviewed: October 2026
---

# Humana Healthy Horizons in Oklahoma ABA coverage (SoonerSelect).

_Payer Guide · Humana Healthy Horizons Oklahoma · Last updated October 2026 · 14 primary sources_

> SoonerSelect MCO. Follows OHCA’s Part 30; PA on 97151/97153/97155/97156, 24-unit initial assessment, 10% case supervision from 10/12/2026.

Humana Healthy Horizons in Oklahoma is one of the three SoonerSelect health plans and, since September 16, 2026, has its own Oklahoma ABA coverage policy (HUM-OK-2663-000). The policy opens with "We follow state manual PART 30. APPLIED BEHAVIOR ANALYSIS (ABA) SERVICES, in addition the following criteria apply," so OHCA’s rules are the baseline and Humana adds unit limits on assessment and reassessment. Two 2026 notices matter for scheduling: reassessments move to 97151 with modifier TS from September 16, and required case supervision rises from 5% to 10% of direct hours on October 12, 2026. Behavioral health is managed in-house; no separate behavioral vendor is named.

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

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — the Prior Authorization and Notification List (eff. 7/1/2026) lists "Applied behavioral analysis therapy — 97151, 97153, 97155, 97156." Policy HUM-OK-2663-000 allows up to 24 units (6 hours) for the initial assessment and up to 16 units (4 hours) every 6 months for a reassessment billed 97151-TS, with exceptions for complex cases. [2][3][4]
- **Prior auth for treatment**: Required — 97153, 97155 and 97156 are on the PA list; the plan says "We follow state manual PART 30," so OHCA’s 1–6 month authorizations and seven-day extension window apply. Request PA at least 14 days before the service date. [2][3][1][9]
- **Autism diagnosis required?**: Yes — the plan follows OHCA Part 30: a definitive ASD diagnosis from a discipline OAC 317:30-5-313 names, with the evaluation no older than two years at the start of ABA. ABA is covered under 21 only. [3][1][7]

## At a glance

- **Plan type:** SoonerSelect health plan (Humana Healthy Horizons); behavioral health managed in-house
- **Clinical rules:** HUM-OK-2663-000 (eff. 9/16/2026): OHCA Part 30 plus Humana unit limits; under 21 only
- **Prior auth:** 97151, 97153, 97155, 97156 (PA list eff. 7/1/2026); request 14+ days before service
- **Assessment units:** Initial up to 24 units (6 hrs); reassessment 97151-TS up to 16 units (4 hrs) every 6 months
- **Case supervision:** 10% of direct hours from 10/12/2026 (was 5%)
- **Fee schedule:** Contracted; state law (56 O.S. § 4002.12) requires at least 100% of the OHCA fee schedule in network; out-of-network paid at 90%
- **Decision clock:** Standard 7 calendar days, expedited 72 hours; extension up to 14 days total
- **PA contact:** Availity preferred; phone 855-223-9868, fax 833-558-9712

## Part 30 plus Humana’s unit limits

Humana’s provider manual lists "Applied behavioral analysis therapy (younger than 21)" as covered and ABA as not covered for adults. Its Oklahoma ABA policy, effective September 16, 2026, adopts OHCA’s Part 30 in full and adds assessment limits: members "may be eligible under the Plan for up to 24 units (6 hours) for an ABA initial assessment," and a reassessment (97151-TS) up to 16 units (4 hours) every six months, with exceptions for complex presentations, co-occurring conditions or major treatment changes. That is tighter than OHCA’s 32-unit ceiling on the FBA, so request to Humana’s number unless an exception applies. The codes are OHCA’s four: 97151, 97153, 97155 and 97156, all on Humana’s Prior Authorization and Notification List. [1][3][2][8]

## 2026 notices and the request mechanics

The June 18, 2026 notice moved reassessment billing to 97151 with modifier TS from September 16, 2026 ("Providers should continue submitting prior authorization requests as they do today"). The July 14, 2026 notice raises required case supervision from 5% to 10% of direct treatment hours effective October 12, 2026, and encourages providers to adopt it earlier. Requests go through Availity (preferred), phone 855-223-9868 or fax 833-558-9712, and the plan asks for PA "at least 14 days in advance of the service date." The manual gives standard decisions "no later than 7 calendar days following receipt of the request for service," expedited within 72 hours. Humana has also published a new manual effective December 23, 2026; its ABA, UM and TPL text is unchanged, and no plan exit has been announced. [4][5][2][1]

## Switching agencies, the payment floor, and joining the network

Follows the SoonerCare rule — Humana’s ABA coverage policy and provider manual set no separate rule for changing agencies: OAC 317:30-5-313: “If a member changes agencies, the comprehensive diagnostic evaluation or clinical assessment will be required during the initial authorization period,” and “An OHCA discharge notification form shall be submitted when a member has completed treatment or the member has moved to a new provider, or will no longer be returning to care.” For a child new to the plan, Humana “honors previously approved care authorizations for 90 days from the day prior to the member’s enrollment date with the plan,” and during that period does not deny PAs because the authorizing provider is out of network. [7][1][11][12][13]

56 O.S. § 4002.12 sets a floor on what SoonerSelect plans pay: at least 100% of the OHCA fee schedule rate for a participating, in-network provider, and 90% of the OHCA rate as of January 1, 2021 for an out-of-network provider. The version in force through October 31, 2026 runs that floor “Until July 1, 2027”; HB 3650 (Laws 2026, c. 310), effective November 1, 2026, extends it to July 1, 2028. Humana’s manual says out-of-network services it has preauthorized “are reimbursed at 90% of the Oklahoma Medicaid fee schedule,” and that after three documented attempts to contract it may pay an out-of-network provider less than the Medicaid fee-for-service rate when the service is not available in network. Whether the plan is adding ABA providers is a question for its provider relations team. [7][1][11][12][13]

## Claims: filing deadline, payment clock, taxonomy and disputes

Humana’s 2026 Oklahoma manual: "You have 6 months from the date of service to submit a claim," and as secondary payer it recommends submitting within 6 months of the other insurer’s payment date. It pays "90% of all clean claims submitted from providers within 14 calendar days from the date of receipt" and 99% within 90 days, and adds 1.5% prorated monthly interest on a clean claim adjudicated after 30 days (electronic) or 45 days (paper). [1][15]

Claims must carry "Billing and rendering taxonomy codes that match the OHCA Master Provider List (MPL)," with billing and rendering addresses that match it too. To dispute a claim outcome, file a reconsideration within 6 months of the written notification (resolved within 30 calendar days), then a formal appeal within 30 calendar days of the reconsideration letter, then an OHCA administrative appeal within 30 calendar days of the appeal decision. The manual’s electronic visit verification requirement sits under home health services (AuthentiCare) and does not mention ABA; confirm with Humana before in-home sessions. [1][15]

## Intake gates

The questions that decide whether a family can start with Humana Healthy Horizons in Oklahoma, and what they have to bring.

- **Age limit**: Follows the SoonerCare rule: Under 21. OAC 317:30-5-313 requires that "The member is under twenty-one (21) years of age," and OHCA provides ABA "under the EPSDT benefit" (OAC 317:30-3-65.12). No lower age bound is set. (OHCA’s provider application page words it as "ages 21 and younger"; the rule text says under 21.) Humana Healthy Horizons in Oklahoma was checked for its own rule on this point and publishes nothing different, so the OHCA rule applies. [7][22][21][3][1]
- **Diagnosis recency**: Follows the SoonerCare rule: The comprehensive diagnostic evaluation or clinical assessment "will only need to be completed at the first initiation of ABA services and should be no older than two (2) years old." No annual or biannual update is required, but OHCA may ask for one if diagnosis and recommendations are unclear or there are significant medical or behavioral changes, and a member who changes agencies must supply the evaluation during the initial authorization period. Separately, disruptive behaviour must be documented within the most recent 30 calendar days. Humana Healthy Horizons in Oklahoma was checked for its own rule on this point and publishes nothing different, so the OHCA rule applies. [7][3][1]
- **Who may diagnose**: Follows the SoonerCare rule: A definitive ASD diagnosis from one of: pediatric neurologist or neurologist; developmental pediatrician; licensed psychologist; psychiatrist or neuropsychiatrist; other licensed physician experienced in the diagnosis and treatment of ASD; or an interdisciplinary team of a licensed psychologist, physician, physician assistant or APRN. The provider must be in Oklahoma or within 50 miles of the border (OAC 317:30-3-89 through 92); out-of-state evaluations are accepted only if they meet the documentation standard and come from one of these disciplines. Humana Healthy Horizons in Oklahoma was checked for its own rule on this point and publishes nothing different, so the OHCA rule applies. [7][3][1]
- **Diagnostic tools required**: Follows the SoonerCare rule: No single instrument is mandatory. The evaluation must include a complete medical and social history and be "based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM)", and "may also include scores" from formal tests such as the ADI-R, ADOS-2 or CARS "or other tools with acceptable psychometric properties." "Screening scales are not sufficient to make a diagnosis and will not be accepted as the only formal scale." For the ABA clinical assessment itself, OHCA cites validated measures such as the Vineland, and accepts supporting assessments such as the ABLLS-R, AEPS and VB-MAPP with the PA request. Humana Healthy Horizons in Oklahoma was checked for its own rule on this point and publishes nothing different, so the OHCA rule applies. [7][17][8][3][1]
- **Referral required?**: Humana’s ABA policy and PA list require prior authorization, not a referral, for ABA; the plan follows OHCA Part 30, which requires none. [3][2][8]
- **Telehealth**: Telehealth "must comply with OHCA policy," be "completed in real time using interactive audio and video," carry written parent consent for minors naming the type, frequency and duration of services, and be "billed with the appropriate modifier." Under OHCA’s rule the modality must be justified in the PA, and OHCA’s telehealth code list carries 97151, 97155 and 97156, not 97153. [1][8][19]
- **Prior-auth decision time**: Standard decisions "no later than 7 calendar days following receipt of the request for service," expedited within 72 hours, with extensions of "up to 7 additional calendar days (for up to 14 calendar days total)"; retro requests within 30 days are decided within 7 calendar days. State law (56 O.S. § 4002.6) deems a complete portal request authorized if the 7-day or 72-hour deadline is missed. Request PA at least 14 days before the service date, and extensions in OHCA’s seven-day window. [1][10][9]
- **Other insurance (who pays first)**: "Humana Healthy Horizons is the payer of last resort," except for IHS, IEP/IFSP school services and crime-victim compensation. The manual adds that "Medicaid’s authorization that an item or service is covered under the plan ... meets the prior authorization requirements of primary coverage," names pay-and-chase for "Preventive pediatric services, including EPSDT" (without saying ABA is handled that way, so bill the primary first), and recommends submitting the secondary claim within six months of the other insurer’s payment. [1][23]

## Delivery and billing rules

Coverage decides whether Humana Healthy Horizons in Oklahoma 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**: From October 12, 2026, required case supervision is 10% of direct treatment hours, up "from 5% to 10%" under Humana’s July 14, 2026 notice (OHCA-approved, "consistent with Council of Autism Service Providers (CASP) guidance"; earlier adoption was encouraged). The notice says the change "applies to clinical oversight activities only and does not change prior authorization requirements, eligibility, … or approved treatment hours." Before that date OHCA’s 5% monthly RBT floor applied. The policy describes RBTs providing ABA "under the close supervision and direction of a BCBA," and OHCA’s conditions for concurrent RBT and supervision billing apply. [5][3][16][8]
- **Concurrent billing (97153 + 97155)**: Follows the SoonerCare rule: Allowed, with conditions. "Providers may only concurrently bill RBT and supervision hours when the following criteria is outlined in the prior authorization request," and the BCBA or licensed psychologist must have directed the RBT in session. "ABA is not allowed to be billed concurrently during any other therapies (i.e., OT, PT speech, etc.)," and "ABA hours approved for one CPT code cannot be used in place of another." Humana Healthy Horizons in Oklahoma was checked for its own rule on this point and publishes nothing different, so the OHCA rule applies. [8][3][1]
- **Daily limits / MUEs**: No per-day unit cap is published. Humana limits the initial assessment to 24 units (6 hours) and a reassessment (97151-TS) to 16 units (4 hours) every six months, with complexity exceptions; OHCA’s intensity tiers and 1–6 month authorizations govern treatment. [3][7][8]
- **Session-note signature**: Follows the SoonerCare rule: Every assessment and treatment service must record the date, start and stop time for each session or unit billed, the physical location, the "Signature of the provider(s) rendering services" and their credentials, goals addressed, methods, progress, the member’s response and any new problems. Treatment plans and updates are "not valid until all signatures are present": the supervising BCBA or licensed psychologist, a parent or legal guardian, and any minor aged 14 or older, each dated with month, day and year. Humana Healthy Horizons in Oklahoma was checked for its own rule on this point and publishes nothing different, so the OHCA rule applies. [17][3][1]
- **Place of service**: Follows the SoonerCare rule: Home, community or clinic ("ABA may be provided in a variety of settings, including home, community, or clinical"). "ABA services are not allowed in a daycare setting or school setting, without OHCA approval. If approved, it will be time-limited to three (3) months or less," with a plan to fade support to school staff; private-school transitions are also capped at three months. School or daycare shadowing and aide work is excluded. Telehealth is allowed if justified in the PA (97151, 97155, 97156 on OHCA’s telehealth code list). Humana Healthy Horizons in Oklahoma was checked for its own rule on this point and publishes nothing different, so the OHCA rule applies. [18][8][19][3][1]
- **Bill as provider** _(ask the plan)_: Humana requires billing and rendering NPIs and taxonomy codes that match the OHCA Master Provider List, and follows Part 30, under which BCaBAs and RBTs are not paid directly and payment goes to the supervising BCBA or employing agency. Humana publishes no ABA-specific rendering-versus-supervising rule. [1][3][20][21]
  - Ask the plan: Humana Healthy Horizons in Oklahoma provider services (855-223-9868): ask whose NPI and taxonomy go in the rendering field for 97153 delivered by an RBT.

## What intake should collect for Humana Healthy Horizons in Oklahoma

- **Plan assignment:** Confirm Humana Healthy Horizons on the member ID card or through the OHCA Provider Helpline (800-522-0114, option 1). ABD and waiver children stay in fee-for-service.
- **Diagnosis report, date and diagnostician:** A definitive ASD diagnosis from a discipline OAC 317:30-5-313 names, in Oklahoma or within 50 miles, no older than two years at the start of ABA.
- **Behaviour from the last 30 days:** Required by the state medical-necessity rule the plan applies.
- **Current authorization end date:** The OHCA seven-day extension window applies to plan members too.
- **Parent training capacity:** Under two hours a month of documented parent involvement reduces or denies hours under the state rule.
- **Assessment hours:** Plan the initial assessment within 24 units (6 hours) unless the case meets Humana’s complexity exception.

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

## Common questions

### Does Humana Healthy Horizons in Oklahoma cover ABA therapy?

Yes, for members under 21, following OHCA Part 30, with prior authorization on 97151, 97153, 97155 and 97156. Adults are not covered.

### How many assessment units does Humana allow?

Up to 24 units (6 hours) for an initial ABA assessment and 16 units (4 hours) every six months for a reassessment billed 97151-TS, with exceptions for complex cases.

### Is Humana changing ABA supervision requirements?

Yes. From October 12, 2026, required case supervision is 10% of direct treatment hours, up from 5%. Humana says the change covers clinical oversight only; it does not change prior authorization, eligibility or approved treatment hours.

### What happens if a family switches ABA agencies with Humana Healthy Horizons in Oklahoma?

The SoonerCare rule applies: an OHCA discharge notification form is filed when the member moves to a new provider, and the diagnostic evaluation or clinical assessment is required during the new agency’s initial authorization period.

### What does Humana Healthy Horizons in Oklahoma pay for ABA?

Rates are contracted, with a state-law floor of 100% of the OHCA fee schedule for in-network providers. Preauthorized out-of-network services are paid at 90% of the Oklahoma Medicaid fee schedule.

### What is Humana Healthy Horizons in Oklahoma’s timely filing limit?

Six months from the date of service (2026 provider manual).

### Does Humana Healthy Horizons in Oklahoma require taxonomy on ABA claims?

Yes. Billing and rendering taxonomy codes must match the OHCA Master Provider List, along with the billing and rendering addresses.

## Primary sources

1. [Humana Healthy Horizons in Oklahoma — provider manual effective 12/23/2026 (NPC996103OK0526; same ABA/UM/TPL text as the May 2026 edition)](https://assets.humana.com/is/content/humana/OK_Provider%20Manual_effective_12232026pdf)
2. [Humana Healthy Horizons in Oklahoma — Prior Authorization and Notification List (eff. 7/1/2026, rev. 9/28/2026)](https://assets.humana.com/is/content/humana/OK%20MCD%20PAL%20Apdf-1)
3. [Humana Medicaid coverage policy HUM-OK-2663-000 — Applied Behavior Analysis (effective 9/16/2026)](https://assets.humana.com/is/content/humana/MCD%20Applied%20Behavior%20Analysis%20HUM-OK-2663-000%20ed%209.16.26pdf)
4. [Humana Healthy Horizons in Oklahoma — ABA assessment and reassessment parameters notice (6/18/2026; eff. 9/16/2026)](https://assets.humana.com/is/content/humana/FINAL_ABA%20Assessment%20Notice%201pdf)
5. [Humana Healthy Horizons in Oklahoma — ABA case supervision update (7/14/2026; eff. 10/12/2026)](https://assets.humana.com/is/content/humana/ABACaseSupervisionNoticepdf)
6. [OHCA — Learn about SoonerSelect (last modified 6/9/2026)](https://oklahoma.gov/ohca/soonerselect/about.html)
7. [OAC 317:30-5-313 — Medical necessity criteria, covered services, frequency and duration Revised 09-01-25](https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/applied-behavior-analysis-services/medical-necessity-criteria-and-covered-services-for-members-under-twenty-one-years-of-age-and-frequency-and-duration.html)
8. [OAC 317:30-5-314 — Prior authorization, service limitations, and exclusions to treatment Revised 09-01-25](https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/applied-behavior-analysis-services/prior-authorization-service-limitations-and-exclusions-to-treatment.html)
9. [OAC 317:30-5-315 — ABA extension requests Revised 09-01-25](https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/applied-behavior-analysis-services/aba-extension-requests.html)
10. [56 O.S. § 4002.6 — SoonerSelect contracted entity prior authorization rules (as amended by HB 1810, eff. 11/1/2025) — OSCN](https://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=489236)
11. [56 O.S. § 4002.12 — SoonerSelect minimum provider reimbursement (as amended by HB 3650, Laws 2026, c. 310, eff. 11/1/2026) — OSCN](https://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=489244)
12. [56 O.S. § 4002.12 — version in force through 10/31/2026 ("Until July 1, 2027") — OSCN superseded document](https://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=553197)
13. [OHCA — SoonerCare Title XIX fee schedule, effective 07/01/2026 (V3)](https://oklahoma.gov/content/dam/ok/en/okhca/docs/providers/claim-tools/fee-schedules/2026/Prov_fee_sch_TXIX_07012026_V3.txt)
14. [Humana Healthy Horizons in Oklahoma — Communications and Network Notices](https://provider.humana.com/medicaid/oklahoma-medicaid/communications)
15. [OAC 317:55-5-25 — SoonerSelect claims processing and methodology; post payment audits Revised 09-01-24](https://oklahoma.gov/ohca/policies-and-rules/xpolicy/managed-care/requirements-for-contracted-entities-and-dental-benefits-managers/finance/claims-processing-and-methodology-post-payment-audits.html)
16. [OAC 317:30-5-311 — Eligible providers and requirements Revised 09-01-25](https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/applied-behavior-analysis-services/eligible-provider-and-requirements.html)
17. [OAC 317:30-5-312 — Treatment plan components and documentation requirements Revised 09-01-25](https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/applied-behavior-analysis-services/treatment-plan-components-and-documentation-requirements.html)
18. [OAC 317:30-5-310 — ABA purpose ("ABA services require prior authorization") Issued 09-12-22](https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/applied-behavior-analysis-services/purpose-aba.html)
19. [OHCA — Medical codes allowed for Telehealth (updated 8-10-26)](https://oklahoma.gov/content/dam/ok/en/okhca/docs/providers/telehealth/Medical%20codes%20allowed%20for%20Telehealth.pdf)
20. [OAC 317:30-5-316 — ABA reimbursement methodology Revised 09-01-25](https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/individual-providers-and-specialties/applied-behavior-analysis-services/reimbursement-methodology.html)
21. [OHCA — Applied Behavioral Analysis Application and Coding Information for Providers](https://oklahoma.gov/ohca/providers/applied-behavioral-analysis-application.html)
22. [OAC 317:30-3-65.12 — ABA services under the EPSDT benefit Revised 09-12-22](https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/general-provider-policies/early-and-periodic-screening-diagnostic-and-treatment-program-child-health-services/applied-behavior-analysis-services.html)
23. [OAC 317:30-3-24 — Third party liability Revised 09-01-25](https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/general-provider-policies/general-scope-and-administration/third-party-liability.html)

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.