Independent Health Association runs NY Medicaid Managed Care under the brand "MediSource" (HARP: MediSource Connect), covering 60,812 members per the state's July 2026 enrollment report — all of them in Erie County, the Buffalo market; the state's own enrollment tables do not list Independent Health under Monroe County, so treat this as a Buffalo/Erie plan rather than a Buffalo-and-Rochester one. Independent Health delegates behavioral health benefit management for its state products to Carelon Behavioral Health — but the evidence points to ABA sitting outside that delegation: the current MediSource member handbook places its ABA section apart from the "Behavioral Health Care" section that carries Carelon's crisis-line branding throughout, describing ABA in "Independent Health covers..." language instead. That distinction isn't stated explicitly in a single provider-facing sentence we could find, so this guide treats it as strongly indicated rather than certain, and flags it as the first thing to confirm on any Independent Health case.
Independent Health states directly, on its current provider policies page, that "Carelon now oversees all behavioral health benefit management services for our MediSource, MediSource Connect, Child Health Plus and Essential Plans" — covering appeals, care management, claims, eligibility, prior authorization, network operations, and utilization review for behavioral health generally. But the 2026 MediSource Member Handbook places its "Applied Behavior Analysis (ABA) Services" description in a separate part of the document — grouped with Children's HCBS and Article 29-I VFCA services rather than the "Behavioral Health Care" (mental health/substance use) section — and describes it in "Independent Health covers..." and "Independent Health will work with you and your provider" language, with no Carelon reference anywhere in that section, while every page of the Behavioral Health Care section footers Carelon's crisis line. That placement is consistent with New York's statewide pattern of no BH-vendor carve-out for the mainstream MMC ABA benefit — but because no single sentence confirms it plainly, verify with Provider Services which entity (Independent Health or Carelon) actually adjudicates ABA authorizations and claims before routing a case to either one.[1][2]
The MediSource handbook states ABA is covered for children/youth under 21 with autism spectrum disorder and/or Rett syndrome, with assessment and treatment delivered by a physician, Licensed Behavior Analyst (LBA), or Certified Behavior Analyst Assistant (CBAA) working under LBA supervision — matching the state's licensure framework. Covered service types named include individual treatment in the home or another setting, group adaptive behavior treatment, and family/caregiver training and support. No Independent Health-specific documentation list (beyond the state's own referral requirements), assessment instruments, or reauthorization cadence is published for MediSource — those specifics, if they exist, sit behind the HealthTrio provider-portal login.[2][7]
What a reauthorization must show. Independent Health (via Carelon) publishes no reauthorization packet or progress-data rule of its own in the documents we checked, so the state’s floor is the reference: the eMedNY ABA manual requires the treatment plan to be updated “at least every 6 months or as needed” with “updated goals and data,” each goal carrying “baseline data reported in objective terms” and “current data expressed by the same data collection method as the baseline data so that progress can be measured.” The state does not require graphs; ask the plan whether it wants graphed data before the first concurrent review.[2][7]
No Independent Health document we could access confirms whether the ABA assessment or treatment codes require prior authorization for MediSource — the handbook's general member-facing PA-required list (out-of-plan services, subacute/SNF admissions, home care, personal care, PERS, mental health, DME, certain surgeries) does not name ABA specifically, but that list is a simplified member summary, not the provider procedure-code grid, so its silence isn't proof no PA is required. No ABA-specific telehealth policy was found either. On billing: Carelon's claims rules for Independent Health's other behavioral-health services set timely filing at 90 days from date of service for MediSource (120 days for Essential Plan/Child Health Plus) — whether that same window applies to ABA claims, or whether ABA bills to Independent Health directly on a different timeline, is unconfirmed. Confirm PA requirements, telehealth eligibility, and the correct claims-filing window with Provider Services before booking or billing.[5][2]
Independent Health sets its own filing limit in its provider agreement and manual; New York law sets the floor. Ins. Law § 3224-a, which covers New York insurers, Article 43 corporations and Article 44 HMOs, requires claims to be submitted within 120 days of the date of service unless the contract is more favorable to the provider — and for Medicaid managed care contracts lets the parties agree on a different period "but in no event less than ninety days." Undisputed claims must be paid within 30 days of receipt when submitted electronically and 45 days on paper, with interest at the greater of the corporate-tax rate or 12% per annum when paid late.[14][15][8][2][9][7]
Electronic Visit Verification does not reach ABA: the Department of Health’s EVV list for fee-for-service and managed care Medicaid covers personal care and home health care codes (CDPAP, home care, HCBS habilitation and respite) and no ABA code (97151–97158).[14][15][8][2][9][7]
For Medicaid managed care specifically, the state’s model contract adds a payment rule: the plan “shall make payments to Participating Providers and to Non-Participating Providers, as applicable, for items and services covered under this Agreement on a timely basis, consistent with the claims payment procedures described in SIL § 3224-a,” and must comply with 42 CFR 447.45(d)(5) and (6).[14][15][8][2][9][7]
Code set: Independent Health publishes no ABA code list of its own in the documents we checked (the MediSource member handbook and its state-products behavioral-health page), so the state’s applies: New York Medicaid’s ABA fee schedule (effective October 1, 2026) and the eMedNY manual’s billing table carry only CPT 97151–97158 — no 0362T or 0373T and no HCPCS H-code (H0031, H0032, H2019, H2014). Bill ABA on the CPT codes; confirm the plan’s fee schedule before billing anything else.[14][15][8][2][9][7]
The questions that decide whether a family can start with Independent Health (NY Medicaid), and what they have to bring. Each maps onto something intake should ask on the first call.
Stated in the plan’s own member handbook and matching the state: the MediSource handbook covers ABA for children and youth under 21 with autism spectrum disorder and/or Rett syndrome. No minimum age; no adult pathway.[2][7]
Follows the New York Medicaid rule — the two-year referral is the clock, and no maximum age is set on the diagnostic evaluation. “No Independent Health-specific documentation list (beyond the state’s own referral requirements), assessment instruments, or reauthorization cadence is published for MediSource”; those specifics, if they exist, sit behind the HealthTrio provider-portal login.[7][2]
Ask the plan: Independent Health Provider Services or the HealthTrio Connect portal — confirm whether MediSource adds a recency rule.
Follows the New York Medicaid rule for the referral, with the handbook restating the delivery side: assessment and treatment are delivered “by a physician, Licensed Behavior Analyst (LBA), or Certified Behavior Analyst Assistant (CBAA) working under LBA supervision.” LBAs and CBAAs may not diagnose or self-refer, so the diagnosing clinician must come from the state’s practitioner list.[2][7]
Follows the New York Medicaid rule: no instrument is mandated. What the state requires with the referral is the “DSM-5 Diagnostic Checklist for ASD diagnoses” plus the severity level when the referral comes from an ASD-diagnosing provider; the treatment plan need only record the assessment methodology used and, “as appropriate, identify standardized assessment used (e.g., adaptive behavior scales, symptom inventories, aggression ratings) and results.” No Independent Health-specific instrument requirement is published for MediSource.[7][2]
Ask the plan: Independent Health Provider Services or the HealthTrio Connect portal.
Follows the New York Medicaid rule: the member “must be referred for ABA services by a NYS-licensed and NYS Medicaid-enrolled physician, psychologist, psychiatric nurse practitioner, pediatric nurse practitioner, or physician assistant,” the referral is “valid for no more than two years,” and it must carry age, the ASD/Rett diagnosis, date of initial diagnosis, co-morbid diagnoses, symptom severity level, a statement the patient needs ABA, and the DSM-5 Diagnostic Checklist. Whether MediSource layers prior authorization on the ABA codes is unresolved: the handbook’s general member-facing PA-required list (out-of-plan services, subacute/SNF admissions, home care, personal care, PERS, mental health, DME, certain surgeries) does not name ABA, but that list is a simplified member summary rather than the provider procedure-code grid, so its silence is not proof. The first thing to settle on any case is which entity adjudicates: Carelon Behavioral Health manages general BH for Independent Health’s state products, while ABA appears from the handbook’s structure to be administered by Independent Health directly — strongly indicated, not stated in one explicit sentence.[7][2][1]
Ask the plan: Independent Health Member/Provider Services (716-250-7183 / 1-833-891-9372) — confirm in writing whether ABA requires PA and whether Independent Health or Carelon adjudicates it.
MediSource behavioral health prior authorization and utilization review are run by Carelon Behavioral Health. Independent Health’s 2026 MediSource handbook sets the clock: standard review “within 3 work days of when we have all the information we need, but you will hear from us no later than 14 days after we receive your request”; fast track “within 72 hours”; a continued-service (concurrent) request within one work day of complete information, no later than 14 days (72 hours if fast-track). Federal rules cap the standard decision at 7 calendar days for plan rating periods starting on or after January 1, 2026, which is tighter than the handbook’s 14. No ABA reauth submission lead time is published; the provider manual is behind the HealthTrio login.[2][1][16]
The NYS Medicaid Telehealth Policy Manual (Version 2026-V2, July 2026) applies to services delivered “under contracted Medicaid Managed Care (MMC) Plans,” lists “Providers licensed or certified by the New York State Education Department (NYSED) to provide Applied Behavioral Analysis (ABA) therapy” among telehealth providers, and requires that “Providers must meet all elements of the procedure code via telehealth.” Its managed-care section says plans “are required to cover, at a minimum, services that are covered by NYS Medicaid FFS and included in the MMC benefit package… and must provide telehealth coverage as described in this guidance,” must “ensure claims allow the use of the telehealth modifiers in this guidance” and “may establish additional claiming requirements.” Billing baseline: modifier 95 or GT for audio-video; place of service 02 (not the home), 10 (the member’s home) or 11 where the in-person visit would be POS 11; payment parity with in-person until April 1, 2028. A code defined as face-to-face with the patient (97152, 97153) qualifies only if every element can be met by video. The state ABA manual separately allows LBA supervision of technicians by synchronous audio-video, but the two monthly supervision contacts must be real time and never by phone, email or text. Independent Health has delegated MediSource behavioral-health utilization review, prior authorization and claims to Carelon Behavioral Health, and neither the MediSource member handbook nor Independent Health’s state-products behavioral-health page carries an ABA telehealth rule; we did not locate Carelon’s New York ABA telehealth instructions. The state rule above is the floor the plan must meet. Neither the state manuals nor the plan say whether the authorization itself must flag telehealth — state the delivery mode in the treatment plan and ask at authorization.[10][7][2][1]
Ask the plan: Carelon Behavioral Health for Independent Health (authorizations 1-855-481-7038) — confirm any ABA telehealth claiming requirement beyond the state baseline (modifier, POS, auth flag) before scheduling remote sessions.
The state rule is clear: Medicaid is “the payer of last resort,” providers “must bill all applicable insurance sources before submitting claims to Medicaid,” and the plan must “alert the provider and ask them to bill the TPHI that should be primary to the Plan.” Independent Health’s own MediSource claim procedure — what to attach, the secondary filing window, and whether Carelon’s ABA authorization is still required when MediSource is secondary — is not in any public document; the provider manual is behind the HealthTrio login and the member handbook is silent.[17][8]
Blocked on: Independent Health provider administrative manual (HealthTrio portal), or Carelon Behavioral Health claims 1-888-249-0478 — ask whether a MediSource ABA authorization is needed when another plan is primary.
Coverage decides whether Independent Health (NY Medicaid) 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.
The MediSource handbook restates New York’s structure — ABA delivered by a physician, an LBA, or a CBAA working under LBA supervision — and the numeric floor comes from the state, applying to managed care alike: 5% of each unlicensed individual’s monthly service hours, at least two face-to-face real-time contacts per month with one observation, and no more than six CBAAs/unlicensed individuals per LBA.[2][7]
Follows the New York Medicaid rule: the LBA supervisor must “review and sign treatment notes and reports prepared by the CBAA supervisee,” and documentation of supervision itself “should be recorded in the patient file.” Clinical documentation must carry the treatment plan with assessment and goals, the goal data, total hours of service per week by who delivered them, and the location(s) of services. Records are kept “for a minimum of six years and, for minors, until the patient turns 22 years of age.” No Independent Health-specific documentation or signature rule was located for MediSource.[7][2]
The MediSource handbook names the covered service types — individual treatment in the home or another setting, group adaptive behavior treatment, and family/caregiver training and support — without publishing a setting restriction of its own. The state rule supplies the limit: any legally authorized setting, but NYS Medicaid does not reimburse ABA in a school setting.[2][7]
Not published. Independent Health’s retrievable ABA content is the member handbook’s benefit description; no claim-edit rule for 97153 with 97155 was located, and the state manual is silent.[2][7]
Ask the plan: Independent Health Provider Services — and confirm first whether Independent Health or Carelon adjudicates ABA claims for the member.
Not published — no authorization periods, unit ceilings or hour-cap logic appear in the MediSource materials we could access, and the state sets no per-day ceiling either. On claims, Carelon’s rules for Independent Health’s other behavioral-health services set timely filing at 90 days from date of service for MediSource (120 days for Essential Plan and Child Health Plus), but whether that window applies to ABA — or whether ABA bills to Independent Health directly on a different timeline — is unconfirmed. Per-day claim edits: the federal Medicaid NCCI medically unlikely edits (October–December 2026: 97153 – 32 units a day, 97155 – 24, 97151 – 32, 97152/97156/97157/97158 – 16, 97154 – 18) are mandatory for fee-for-service claims, but CMS calls applying them to managed-care claims “desirable but optional,” and Independent Health does not say whether it applies them — treat the authorized units as the ceiling and ask the plan about any per-day edit.[11][12][2][1]
Ask the plan: Independent Health Provider Services — confirm authorization periods, unit limits and the correct claims-filing window for ABA specifically.
Not published, and the routing question comes first: confirm whether Independent Health or Carelon Behavioral Health actually adjudicates ABA authorizations and claims for the member before submitting anything, since the public materials do not settle it explicitly. At the fee-for-service layer New York is explicit: LBAs bill “using the LBA’s National Provider Identification (NPI) number for the ‘Billing’ provider and/or ‘Supervising’ provider,” with “the NPI number of the CBAA that provided the ABA service… reported as the ‘Rendering’ provider on each claim”; for unlicensed aides and LBA limited-permit holders the supervising LBA’s NPI fills all three roles. CBAAs cannot bill directly and enroll as OPRA providers.[1][2][7]
Ask the plan: Independent Health Provider Services — confirm the adjudicating entity, the rendering/supervising NPI convention and the claims-filing window.
Yes — its MediSource Medicaid plan covers ABA for members under 21 with ASD and/or Rett syndrome, delivered by an LBA or an LBA-supervised CBAA, per the current member handbook.
Carelon manages general behavioral health for Independent Health's state products, but ABA appears to be administered by Independent Health directly based on how the member handbook separates the two benefits — not confirmed in one explicit sentence, so verify with Provider Services before routing a case.
No — the state's Medicaid Managed Care enrollment tables list Independent Health only under Erie County (Buffalo), not Monroe County.
Six at a time. New York Medicaid, which applies the rule to fee-for-service and managed care alike, says an LBA "can supervise no more than six CBAAs/unlicensed individuals at a time," must supervise each for at least 5% of their monthly service hours, and must hold at least two face-to-face real-time contacts a month, observing service delivery in one. In New York the supervisor must be a NYSED-licensed behavior analyst; BCBA certification alone is not a license.
Your contract sets it, but New York Ins. Law § 3224-a bars a Medicaid managed care contract from setting less than 90 days from the date of service (120 days is the default without a contract term). Clean electronic claims must be paid within 30 days, paper within 45.
Not on anything Independent Health publishes. It posts no ABA code list of its own, and the New York Medicaid ABA fee schedule it builds on lists only CPT 97151–97158, with no H-codes and no 0362T/0373T. Bill ABA on the CPT codes.
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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