InterCommunity Health Network CCO (IHN-CCO), administered by Samaritan Health Plans, serves OHP members in Benton, Lincoln and Linn counties. Its 2026 Prior Approval List names "Applied behavioral therapy (ABA) services," and its 2026 code list spells out the codes, so the assessment needs approval here.
IHN-CCO’s 2026 Prior Approval List includes "Applied behavioral therapy (ABA) services," and the IHN Prior Authorization List Code List (effective January 1, 2026) lists under that heading 97151, 97152, 97153, 97154, 97155, 97156 and 97157, plus the team-conference codes 99366 and 99368. Samaritan’s Utilization Management and Service Authorization Handbook (2025) lists its criteria sources: the OHA Prioritized List, guideline notes, Oregon Administrative Rules, statutes, Samaritan coverage policies and MCG guidelines. That handbook prints IHN-CCO timeframes of 14 days standard and 72 hours expedited; OAR 410-141-3835, effective July 1, 2026, requires CCO notice within 7 calendar days for standard requests.[2][3][4][13][5][12]
On rates, Samaritan’s behavioral health provider page says that under OHA’s 2023 directed payment IHN-CCO "will adopt/maintain the fee schedule for A&D Residential, Applied Behavior Analysis and Mental Health Children’s Wraparound services at no lower than the OHA State Plan Medicaid Behavioral Health Fee-For-Service fee schedule rate in effect at the date of service," and that its contracts carry "lesser of billed charges" language, so bill at a rate that captures any increase. OHA’s fee-for-service behavioral health fee schedule (update published 7/1/2026) pays, per 15-minute unit: 97151 $20.85, 97152 $19.81, 97153 $14.70, 97154 $13.72, 97155 $32.07, 97156 $32.07 and 97157 $8.68 (rates effective 7/1/2024). 97158, 0362T and 0373T do not appear on the schedule.[2][3][4][13][5][12]
OHA’s managed-care billing rule binds every CCO, IHN-CCO included (OAR 410-141-3565, effective January 1, 2025). Initial claims are due "within no more than 120 days of the date of service," or within 365 days for pregnancy, retroactive eligibility, Medicare as primary payer, third-party liability and other delays not caused by the provider; a CCO "may negotiate terms within this timeframe," so your contract can set a shorter limit but not a longer one. For a timely claim that needs correction or resubmission, the CCO must allow "a minimum of 180 days after the initial adjudication date." Other insurance "must be exhausted prior to payment." On payment, CCOs "shall pay or deny at least 90 percent of valid claims within 30 days of receipt and at least 99 percent of valid claims within 90 days of receipt," make an initial determination on 99 percent within 60 days, and "may not require providers to delay claims submission." The rule sets no weekly payment cycle or submission cutoff.[1]
The questions that decide whether a family can start with InterCommunity Health Network CCO (IHN-CCO), and what they have to bring. Each maps onto something intake should ask on the first call.
IHN publishes no age limit. OHP rules require ABA beyond Guideline Note 75 when medically appropriate "including individuals age 13 and older," and under 21 EPSDT bars age-group-wide denials.[4][9][17]
IHN publishes no recency rule. The OHP rule dates only the physical exam and hearing test (OAR 410-172-0770(1)(h)–(i)).[4][9]
IHN publishes nothing different, so the OHP rule applies: a physician, psychologist, or developmental-medicine NP or PA experienced in autism (OAR 410-172-0770(1), 0760(1)).[4][9][8]
IHN publishes nothing different, so the OHP rule applies: a standardized, validated tool such as the ADOS plus developmental status on assessments such as the Vineland (OAR 410-172-0770(1)(b), (g)).[4][9]
IHN adds no referral rule of its own, so the OHP rule applies. Yes. Before services, OAR 410-172-0770(1)(k) requires "A referral for ABA treatment with or without specification of hours or intensity" that includes the diagnosis and a copy of the evaluation, from a physician, psychologist, or nurse practitioner or physician associate specializing in developmental medicine who has experience diagnosing and treating autism (OAR 410-172-0760(1)).[4][9][8]
IHN publishes no ABA telehealth rule of its own. The state rule applies: "For purposes of behavioral health services, the Authority shall provide coverage for telemedicine services to the same extent that the services would be covered if they were provided in person" (OAR 410-172-0850(5)), using synchronous two-way video (telephone and e-mail only where HERC guidelines allow). OHA’s behavioral health fee schedule lists modifier GT ("Via Interactive Simultaneous Audio and Video Telecommunication Systems") as an allowable modifier on every ABA code it prices, 97151 through 97157, including the 97151 assessment and 97155 protocol modification.[4][11][12]
IHN’s documents read add nothing ABA-specific, so the state rule applies. Medicaid pays last. OHA must be "the payer of last resort," and "Providers shall make reasonable efforts to obtain payment first from other resources" (OAR 410-120-1280; 42 CFR 433.139). Bill the commercial plan first and follow its authorization rules.[4][16][21]
Samaritan’s 2025 UM handbook prints IHN-CCO timeframes of 72 hours expedited and 14 days standard. OAR 410-141-3835 (effective July 1, 2026) requires CCO notice "no later than seven (7) calendar days following receipt," so expect 7.[4][13]
Ask the plan: Samaritan Health Plans care management for IHN-CCO: confirm the current standard decision timeframe.
Coverage decides whether InterCommunity Health Network CCO (IHN-CCO) 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.
IHN publishes no ABA supervision rule, so the state rule applies. OHA does not pay assistant behavior analysts or registered behavior analysis interventionists directly (OAR 410-172-0760(4)); they work under a directly payable Licensed Behavior Analyst, licensed health care professional or declarant. The licensing rule sets the interventionist supervision floor: direct and indirect supervision "for at least 5 percent of the interventionist’s service hours," including direct supervision at least once per calendar month, by a licensed behavior analyst, licensed assistant behavior analyst or licensed health care professional (OAR 824-040-0010). Direct supervision may be remote if it is synchronous audio and video (OAR 824-010-0005).[2][8][15]
IHN publishes no ABA session-note rule. The OHP floor applies: each note "signed or initialed by the individual providing the service" (OAR 410-172-0620(4)).[4][10]
IHN publishes no ABA rendering-provider rule. The OHP rule applies: only a Licensed Behavior Analyst, licensed health care professional or declarant is eligible for direct payment (OAR 410-172-0760(3)–(4)).[3][8]
Not addressed in IHN’s prior approval list, code list or UM handbook.[3][4]
Ask the plan: Samaritan Health Plans provider services for IHN-CCO, or your IHN-CCO contract.
IHN publishes no ABA unit or hour limit.[3][4]
Ask the plan: Samaritan Health Plans care management (IHN-CCO authorizations): ask how ABA units are authorized.
IHN publishes no ABA setting rule.[3]
Ask the plan: Samaritan Health Plans provider services for IHN-CCO: ask which settings and place-of-service codes it pays for ABA.
120 days from the date of service under OAR 410-141-3565 (365 days for exceptions such as retroactive eligibility, Medicare or other insurance primary); your contract may set a shorter limit. Corrections and resubmissions get at least 180 days from the initial adjudication.
Yes. IHN’s 2026 code list includes 97151 and 97152 under ABA services, so request approval before the assessment.
Contracted rates, which IHN says it keeps no lower than the OHA fee-for-service behavioral health rate for ABA. The OHA open-card rate for 97153 is $14.70 per 15 minutes.
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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