---
title: Magellan Behavioral Health of Pennsylvania ABA coverage (HealthChoices IBHS).
url: "https://carelu.com/payers/magellan-behavioral-health-pennsylvania"
markdown_url: "https://carelu.com/payers/magellan-behavioral-health-pennsylvania.md"
state: PA (Pennsylvania)
payer: Magellan Behavioral Health of Pennsylvania (HealthChoices BH-MCO)
kind: Medicaid managed care plan (MCO)
parent_program: Pennsylvania Medicaid (Medical Assistance)
description: "How Magellan Behavioral Health of Pennsylvania authorizes ABA under HealthChoices IBHS in Bedford, Bucks, Cambria, Lehigh, Montgomery, Northampton and Somerset counties: the 97151 HA assessment registration, the TAR packet, 6-month authorizations, telehealth POS 02/10 + FQ, and the primary-insurance-first rules."
last_reviewed: October 2026
---

# Magellan Behavioral Health of Pennsylvania ABA coverage (HealthChoices IBHS).

_Payer Guide · Magellan Behavioral Health (PA) · Last updated October 2026 · 14 primary sources_

> HealthChoices BH-MCO, 7 counties; IBHS ABA — 97151 registration (96 units/45 days), 6-month treatment auths via Availity.

Magellan Behavioral Health of Pennsylvania is the HealthChoices behavioral health managed care organization (BH-MCO) for Medicaid members in Bedford, Bucks, Cambria, Lehigh, Montgomery, Northampton and Somerset counties. In Pennsylvania Medicaid, ABA is not a stand-alone autism benefit: it is the ABA category of Intensive Behavioral Health Services (IBHS) under 55 Pa. Code Chapters 1155 and 5240, open to children, youth and young adults under 21 with any behavioral health diagnosis, and started by a written order.

Magellan’s mechanics are published on magellanofpa.com: the ABA initial assessment is opened by a registration (not a medical-necessity review) that authorizes 96 units over 45 days; treatment is authorized from a full packet (TAR, written order, assessment, ITP, plus CANS and an ISPT meeting note where they apply) submitted in Availity; and authorizations run a maximum of 6 months (Somerset-Bedford ABA up to one year). Magellan has also announced a Blair County HealthChoices contract going live January 1, 2027.

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

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Registration only — the initial ABA assessment (authorization code 97151 HA) is opened with the IBHS Registration TAR plus the written order through Availity, and Magellan authorizes 24 hours (96 units) over 45 calendar days; there is no medical-necessity review at this step. Ongoing reassessments are done within the approved BC-ABA units before the reauthorization request. [2][3][15]
- **Prior auth for treatment**: Yes — pre-service and concurrent requests go through Availity with the TAR for Individual/ABA IBHS, the written order (completed within 1 year), the assessment with specific service recommendations, the ITP, a CANS summary for members 3 and older (Bucks, Cambria, Lehigh, Montgomery, Northampton), and an ISPT meeting summary when BHT-ABA is requested in school, daycare, preschool, camp or after-school programs. Authorizations run a maximum of 6 months (Somerset-Bedford ABA up to one year). [3][2][5]
- **Autism diagnosis required?**: No autism diagnosis required — IBHS ABA serves children, youth and young adults with a behavioral health diagnosis. Magellan’s written order must include a behavioral health diagnosis (its TAR asks for the DSM-5 diagnosis with ICD-10 code); Magellan publishes nothing narrower than the state rule. [2][16][21]

## At a glance

- **Plan type:** HealthChoices BH-MCO (behavioral health carve-out) — ABA is delivered as IBHS ABA services
- **Counties:** Bedford, Bucks, Cambria, Lehigh, Montgomery, Northampton, Somerset (Blair contract announced to go live 1/1/2027)
- **Assessment (97151):** Registration via Availity with the IBHS Registration TAR + written order — 96 units (24 hours) over 45 calendar days for ABA; no medical-necessity review
- **Treatment PA:** Yes — TAR + written order + assessment + ITP (+ CANS age 3+ in Bucks/Cambria/Lehigh/Montgomery/Northampton; ISPT note for BHT-ABA in school-type settings)
- **Authorization length:** Maximum 6 months (Somerset-Bedford ABA up to one year)
- **Decision clock:** 2 business days pre-service, 1 business day concurrent (after complete information); RAI within 48 hours
- **Telehealth:** POS 10 (member’s home) or 02 (elsewhere); FQ modifier for audio-only; GT no longer allowed
- **Fee schedule:** Not published — the HealthChoices supplement posts no ABA rate table; ask Magellan network management
- **Other coverage:** Medicaid is last payer — bill the primary first; the IBHS packet still goes to Magellan when there is TPL

## How ABA works under Magellan: IBHS, not an autism benefit

Magellan’s handbook supplement describes IBHS as three categories — individual services, ABA, and group services — delivered in home, school and community. Everything starts with a written order (WO) based on a face-to-face interaction: it must name a behavioral health diagnosis, the IBHS service, hours and settings, the clinical information supporting medical necessity, and measurable improvements for reducing or ending services. Magellan requires the WO writer to be a licensed physician, licensed psychologist, CRNP or other licensed practitioner whose scope includes diagnosing and treating behavioral health disorders and prescribing IBHS, and to be ORP (Ordering/Referring/Prescribing) enrolled. Written orders are valid for 12 months; updates within that window need no new face-to-face visit but can only be made by the original order writer. [2][4][10]

Magellan wants ABA recommendations written as service lines and hours, not CPT codes: its 2025 training says recommendations must be made as BC-ABA and BHT-ABA and "Should not be listed as CPT codes". The authorization codes are buckets — BC-ABA is authorized as 97151 HO and billed as 97151/97155/97156 with HO (plus HA when a behavior analyst renders); BHT-ABA is authorized as 97152 HO and billed as 97152/97153 HO (HO HA for assistant behavior consultation-ABA). [2][4][10]

## Assessment registration, then the treatment packet

- **Initial assessment registration:** Submit the IBHS Registration TAR cover sheet and the written order through Availity. Magellan authorizes 24 hours (96 units) over 45 calendar days for an ABA assessment (97151 HA); regulation still expects it completed within 30 calendar days. Providers have 7 calendar days to schedule the first assessment appointment after receiving a verified written order. [3][15][16][2]
- **Assessment content:** Face-to-face, across settings, with a standardized tool or process such as an FBA ("Vineland/VBMAPP/FBA as applicable/ABAS-3/AFLS" are Magellan’s examples) and recommendations in hours per month per setting. [3][15][16][2]
- **Treatment packet:** TAR for Individual/ABA, written order (within 1 year), assessment with specific recommendations, ITP, CANS summary for members 3+ (not Somerset-Bedford), and an ISPT meeting summary when BHT-ABA is requested in school, daycare, preschool, camp or after-school settings. [3][15][16][2]
- **Start dates and reauths:** The requested start date cannot be more than 2 business days before submission; reauthorization packets may go in no more than 30 days before the last covered day. [3][15][16][2]
- **Mid-auth changes:** Change of prescription, 1–30 day administrative extensions, transfers and error corrections go by fax with the documents on Magellan’s 2026 checklist. [3][15][16][2]

## Decision timelines and authorization length

The supplement’s table: pre-service urgent up to 3 hours, pre-service standard 2 business days, concurrent review 1 business day, retro review 30 calendar days. If information is missing Magellan requests it within 48 hours, the provider has up to 14 calendar days to answer, and the decision follows within 2 business days (initial) or 1 business day (concurrent) of receipt. These mirror the DHS HealthChoices Appendix AA standards, which also deem a service approved if the member has no written decision within 21 days of the request. [2][5][9]

Magellan’s July 2026 workgroup deck states "Magellan auths are all a maximum of 6 months", with a footnote that Somerset-Bedford ABA authorizations can run up to one year. [2][5][9]

## Primary insurance first — but the packet still goes to Magellan

Magellan’s supplement: "Medicaid is always the last payer"; claims go to the primary insurer first for an EOB, and "HealthChoices will not make payments if the full obligations of the primary insurer are not met." When the service is covered by the other insurance, the member must use a provider in both networks. Magellan’s training adds that it "cannot reimburse as primary payer because your agency is out of network with the primary insurance", but can pay as primary when the primary plan’s benefit is exhausted or the service is not covered — and that even with TPL, the IBHS packet "still needs to be submitted to MBH". [2][4][5][17]

For Act 62 (autism) children the supplement tells providers to bill the private insurer first "even if a denial was previously received" and send evidence of exhaustion or denial. When the primary denies, Magellan accepts retrospective review requests within 180 days of the primary’s final decision, with the EOB or denial letter attached. [2][4][5][17]

## Rates

Magellan pays IBHS under provider contracts and fee schedules that are not published. Its July 2026 workgroup notes recent rate increases and asks providers to bill usual-and-customary charges so claims can be swept up to new rates, and describes a 2026 access-based incentive model (at least 25 individual or ABA initial assessments a year; members with commercial insurance are not counted). Confirm your contracted rates with Magellan Network. [5]

## Switching ABA providers at Magellan: the IBHS transfer process

Magellan publishes an IBHS transfer process, and the authorization does not simply move — the receiving provider asks for its own. Once a receiving provider is identified, the currently authorized provider sends it “a copy of the approved packet” and “a statement on letterhead acknowledging the transfer of the member and noting the mutually agreed upon date of transfer”; “no Magellan discharge form needs to be submitted.” The receiving provider then submits through the provider portal the current provider’s letter, its own letter on letterhead with the same agreed transfer date, and a “TAR to ensure accuracy of new authorization.” Members who ask to transfer are encouraged to discuss it with their current provider first, and for managed levels of care the care manager tells the treating provider by phone before the transfer. [2]

## Is Magellan's network open to new ABA providers, and how is ABA paid?

Every provider — organization, individual practitioner or group — must sign a Magellan Provider Participation Agreement to accept referrals and be paid, must be actively enrolled in PA Medical Assistance for the contracted services, and is credentialed under 28 Pa. Code §§ 9.761–9.762. Magellan’s supplement describes network inclusion as an application that can be declined (“If you apply for network inclusion and are declined, Magellan will provide written notice of the reason”), existing providers “may not be eligible to expand services while they are under a corrective action plan,” and new in-lieu-of or in-addition-to services need letters of support from both Magellan and the county. It does not state whether IBHS-ABA is currently open in a given county, and it posts no ABA rate table — ask Magellan network management for both. [2]

## What are Magellan’s claim filing, payment and appeal rules?

Magellan’s Pennsylvania HealthChoices supplement (rev. 11/25): claims must be received “within 60 days of the date of service for most levels of care,” and third-party (secondary) claims within 60 days of the other carrier’s EOB, which must be attached. Resubmissions of claims with billing errors are due “within 60 days of the date on Magellan’s explanation of benefits.” Magellan “will pay clean claims within 45 days of the date of receipt,” with 10 percent annual interest on late clean claims. A written claim appeal with supporting documentation goes to Claim Appeals (ClaimAppealsPAHC@MagellanHealth.com) and is decided within 30 days; “No claim appeal will be considered past 365 days from the date of service.” After that comes the two-level provider complaint process. [2][13]

On the claim, services that require ordering, referring or prescribing (ORP) data under OMHSAS rules must carry it on every submission, and every ORP practitioner reported must be actively enrolled in Pennsylvania Medicaid; the IBHS written-order writer must be ORP-enrolled. Procedure codes and modifiers come from your Magellan agreement and reimbursement schedules, not a public list. The supplement states no taxonomy rule for claims and does not mention EVV; DHS applies EVV only to personal care and home health services delivered in the home. [2][13]

## Intake gates

The questions that decide whether a family can start with Magellan Behavioral Health of Pennsylvania (HealthChoices BH-MCO), and what they have to bring.

- **Age limit**: Under 21 — IBHS serves children, youth and young adults under 21 (55 Pa. Code Chs. 1155/5240). No minimum age. Magellan publishes nothing different. [10][2]
- **Diagnosis recency**: No separate diagnosis-age rule; what must be current is the written order. Magellan: the order must be written within 1 year/365 days of the face-to-face evaluation and is valid 12 months from the recommendation; a written order that expires mid-authorization "will not impact or interrupt service delivery", but a new one is needed for continued services. [4][2]
- **Who may diagnose**: The written order (which carries the diagnosis) can come from a licensed physician, licensed psychologist, certified registered nurse practitioner, or other licensed practitioner whose scope includes diagnosing and treating behavioral health disorders and prescribing IBHS; Magellan requires the writer to be ORP-enrolled. A psychiatric/psychological evaluation or best-practice evaluation containing all written-order elements can substitute. [2][4]
- **Diagnostic tools required**: No named instrument is required behind the diagnosis. The tool requirement sits in the IBHS assessment: Magellan requires "A standardized assessment tool or process such as an FBA" (examples: Vineland, VB-MAPP, ABAS-3, AFLS) with the analysis submitted in the packet, and a CANS for members 3+ in its non-Somerset-Bedford counties. [4][2]
- **Referral required?**: A written order is required to start (face-to-face, within 12 months, ORP-enrolled writer, naming diagnosis, service lines, maximum hours per month using "up to" language, settings and discharge markers). Families can take the order straight to an IBHS agency; Magellan’s Referral for IBHS Assessment form (current written order and authorization to disclose attached) is for Magellan-assisted placement — and Magellan "is unable to make referrals for children with Act 62 benefits through their Primary Insurance Policy". [7][4]
- **Telehealth**: Allowed per OMHSAS-22-02, which asks providers to weigh clinical appropriateness carefully for IBHS. Magellan: bill the normal contracted code/modifiers with POS 10 when the member is at home or POS 02 elsewhere (the member’s location, not the provider’s); add informational modifier FQ in the last position for audio-only, which is allowed only without video access or for an urgent situation; GT is no longer allowable. Document consent, mechanism, platform and any audio-only rationale. [6][2][18]
- **Prior-auth decision time**: Pre-service standard 2 business days; concurrent 1 business day; pre-service urgent up to 3 hours; retro review 30 calendar days. Missing information is requested within 48 hours, the provider gets up to 14 calendar days, then a decision within 2 business days (initial) or 1 business day (concurrent). DHS Appendix AA adds that a service is automatically approved if no written decision reaches the member within 21 days. Federal 42 CFR 438.210(d) caps standard decisions at 7 calendar days (expedited 72 hours) for rating periods from 1/1/2026 — Magellan’s published clock is faster. Reauth packets: no more than 30 days before the last covered day; start date no more than 2 business days before submission. [2][9][19]
- **Other insurance (who pays first)**: Magellan is always the last payer: bill the primary first for an EOB, and use a provider in both networks when the primary covers the service. Magellan will not pay as primary because the agency is out of network with the primary, but can when the primary benefit is exhausted or the service is not covered. Its own authorization is still needed when commercial is primary — "If there is TPL involved, packet still needs to be submitted to MBH". For Act 62 children, bill the private insurer "even if a denial was previously received"; retro review is available within 180 days of the primary’s final decision with the EOB. If the primary does not cover telehealth, seek pre-authorization through Magellan as secondary. When TRICARE is also present it pays ahead of Medicaid: 10 U.S.C. 1079(i)(1) makes TRICARE secondary to other coverage "except in the case of a plan administered under title XIX". [2][4][6][17][20]

## Delivery and billing rules

Coverage decides whether Magellan Behavioral Health of Pennsylvania (HealthChoices BH-MCO) 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**: Follows the state IBHS rule (Magellan publishes nothing different): under 55 Pa. Code § 5240.82 a clinical-director-qualified supervisor gives behavior analytic and BC-ABA staff 1 hour of individual face-to-face supervision a month (plus a second hour if they supervise assistant BC-ABA or BHT-ABA staff) and 30 minutes of direct observation every 6 months; BHT-ABA staff get 1 hour weekly if working 37.5+ hours a week, otherwise 1 hour twice a month, including 1 hour of individual face-to-face supervision each month, plus 6 hours of onsite supervision before working independently. [11][2]
- **Session-note signature**: State rule plus Magellan’s documentation standards. 55 Pa. Code § 5240.41 requires each service note to carry the signature of the staff person providing the service. Magellan’s supplement requires entries "signed and dated by the responsible licensed provider" (ancillary staff countersigned), clock start/end times, and a member (or agent) signature on the encounter form per MA Bulletin 99-89-05 — for telehealth, hand-written or audited electronic signatures, obtained "no later than 90 days after the service". Magellan’s 2026 audit list flags an electronic signature that precedes the session end time. [2][8][11]
- **Place of service**: Home, school and community per the IBHS rules. Magellan treats preschool, daycare, after-school programs, summer camp, school and ESY as "SCHOOL" for BHT-ABA, requires an ISPT meeting summary for BHT-ABA in those settings, lists POS 03 (school), 11, 12 and 99 among its codes, and says to bill 97156 with a teacher or daycare staff using POS 99. Claims must use a contracted rendering service location — "Do not bill using a member’s home address". [4][5][2]
- **Bill as provider**: The IBHS agency bills. Magellan wants one Type 2 NPI per rendering service location; group providers also report the rendering practitioner’s Type 1 NPI (CMS-1500 box 24J / loop 2310B). The credential of whoever rendered is carried in the contracted modifiers — e.g., 97155 HO for BC-ABA vs 97155 HO HA for a behavior analyst; 97153 HO for BHT-ABA vs 97153 HO HA for assistant BC-ABA — listed "in the order that they show on the fee schedule". ORP-required claims must carry the enrolled order writer. [2][4][5]
- **Daily limits / MUEs** _(plan-dependent)_: No per-day unit ceiling is published. Magellan authorizes hours per month per service line and computes units with its calculator; each contracted code carries its own unit definition and permissible POS in your provider contract. The state FFS code list’s per-day unit ranges (OMHSAS-21-03) are fee-for-service only and tell managed-care providers to ask the BH-MCO. [4]
  - Ask the plan: Your agency’s Magellan HealthChoices contract and fee schedule (unit definitions per code), or Magellan Provider Services (Bucks/Montgomery 877-769-9779; Lehigh/Northampton 866-780-3368; Cambria, Somerset/Bedford 800-424-3711).
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: Magellan of PA IBHS team (IBHS@MagellanHealth.com) or your Magellan Network Management Specialist — ask whether 97155 HO/HO HA may be billed for the same minutes as 97153 HO when the analyst directs the technician, and get the answer in writing. [4][8]

## What intake should collect for Magellan Behavioral Health of Pennsylvania (HealthChoices BH-MCO)

- **Medicaid ID and county:** Magellan covers only its seven counties; the TAR asks which county the member’s MA is tied to, and a county change needs a new authorization line.
- **Written order (within 12 months):** Face-to-face order from an ORP-enrolled licensed physician, psychologist, CRNP or other licensed prescriber naming a DSM/ICD behavioral health diagnosis, ABA service lines, maximum hours per month, settings and discharge markers.
- **Primary insurance card and ABA benefit:** If the child has commercial coverage, bill it first; you must be in network with the primary for Magellan to pay secondary. Keep EOBs/denial letters.
- **School/daycare contacts:** BHT-ABA in school, daycare, preschool, camp or after-school settings needs an ISPT meeting summary in the packet.
- **Caregiver availability for the assessment:** Magellan’s referral form asks for caregiver days/times; the assessment must cover every setting where services will be delivered.
- **Consent to release information:** Magellan’s referral form requires written consent before it can send clinical information to providers.

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

## Common questions

### What is Magellan of Pennsylvania’s timely filing limit?

Sixty days from the date of service for most services, 60 days from the other carrier’s EOB for secondary claims, and 60 days from Magellan’s EOB for resubmissions.

### How fast does Magellan pay a clean claim in Pennsylvania?

Within 45 days of receipt, with 10 percent annual interest on clean claims paid late.

### Does Magellan of Pennsylvania require prior authorization for the ABA assessment?

It requires a registration, not a medical-necessity review. Submit the IBHS Registration TAR and the written order in Availity; Magellan authorizes 96 units (24 hours) over 45 calendar days for the ABA initial assessment (97151 HA). Reassessments are done within the approved BC-ABA units before the reauthorization request.

### Does my child need an autism diagnosis for ABA through Magellan?

No. IBHS ABA is available to children, youth and young adults under 21 with a behavioral health diagnosis; the written order must name a DSM/ICD behavioral health diagnosis, which need not be autism.

### How long does a Magellan IBHS authorization last?

Up to 6 months per Magellan’s 2026 workgroup materials; Somerset-Bedford ABA authorizations can run up to one year. Reauthorization packets may be submitted up to 30 days before the last covered day.

### My child has private insurance too. Does Magellan still need a packet?

Yes. Bill the private plan first (Medicaid is the last payer), but Magellan’s training says the IBHS packet still needs to be submitted to Magellan when there is TPL. Magellan will not pay as primary just because your agency is out of network with the primary plan.

### Does the authorization transfer if a family switches ABA agencies under Magellan?

Not by itself. The current provider sends the receiving provider the approved packet and a transfer letter with the agreed date; the receiving provider submits both letters and a new TAR through the portal “to ensure accuracy of new authorization.” No discharge form is needed.

### How do we bill ABA telehealth to Magellan?

Use your normal contracted code/modifier combination with POS 10 when the member is at home or POS 02 elsewhere; add informational modifier FQ in the last position for audio-only. The GT modifier is no longer allowed.

## Primary sources

1. [Magellan of PA — Intensive Behavioral Health Services (IBHS) provider page](https://www.magellanofpa.com/for-providers/services-programs/intensive-behavioral-health-services-ibhs/)
2. [Magellan Behavioral Health of PA — Provider Handbook Supplement for HealthChoices (rev. 11/25)](https://www.magellanprovider.com/media/1661/pa_healthchoices_supp.pdf)
3. [Magellan of PA — IBHS Authorization Request Checklist (rev. 02/12/2026)](https://www.magellanofpa.com/documents/2026/02/021626_ibhsauthrequestchecklist.pdf)
4. [Magellan of PA — IBHS/ABA New Provider Training (Somerset-Bedford, Nov. 2025)](https://www.magellanofpa.com/documents/2025/11/s-b-new-provider-training-ibhsaba-11052025.pdf)
5. [Magellan of PA — IBHS Provider Workgroup, July 30, 2026](https://www.magellanofpa.com/documents/2026/07/073126_ibhsproviderworkgrouponjuly302026.pdf)
6. [Magellan of PA — Telehealth FAQ for Providers (as of June 1, 2023)](https://www.magellanofpa.com/documents/2023/06/060123_updatedtelehealthfaq.pdf)
7. [Magellan of PA — Referral for IBHS Assessment (rev. 11/01/2025)](https://www.magellanofpa.com/documents/2021/07/p-forms-referral-for-ibhs-assessment.pdf)
8. [Magellan of PA — Audit Trends (June 2026)](https://www.magellanofpa.com/documents/2026/06/061226_audittrendsasofjune2026.pdf)
9. [DHS HealthChoices BH Program Standards and Requirements, Appendix AA — Prior Authorization Requirements (Jan. 1, 2026)](https://s18637.pcdn.co/wp-content/uploads/sites/79/Appendix-AA-Prior-Authorization-Requirements.pdf)
10. [55 Pa. Code Chapter 1155 — Intensive Behavioral Health Services (payment)](https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/055/chapter1155/chap1155toc.html)
11. [55 Pa. Code Chapter 5240 — Intensive Behavioral Health Services (licensing)](https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/055/chapter5240/chap5240toc.html)
12. [PA DHS — Behavioral Health Managed Care Organizations (BH-MCOs) by county](https://www.pa.gov/agencies/dhs/resources/medicaid/bhc/bhc-mcos)
13. [PA DHS — Electronic Visit Verification (EVV) and EVV FAQ](https://www.pa.gov/agencies/dhs/resources/for-providers/evv/faq-evv)
14. [Magellan of PA — Providers page (Provider Announcements and Compliance Alerts archive)](https://www.magellanofpa.com/for-providers/)
15. [Magellan of PA — IBHS TAR Registration Cover Sheet (rev. 11/01/2025)](https://www.magellanofpa.com/documents/2021/07/p-forms-ibhs-tar-registration-cover-sheet.pdf)
16. [Magellan of PA — IBHS TAR Facesheet for Individual & ABA IBHS (rev. 11/01/2025)](https://www.magellanofpa.com/documents/2025/09/ibhs-tar-facesheet-for-individual-aba-ibhs.pdf)
17. [55 Pa. Code § 1101.64 — Third-party medical resources (TPR)](https://www.pacodeandbulletin.gov/Display/pacode?file=/secure/pacode/data/055/chapter1101/s1101.64.html)
18. [OMHSAS-22-02 — Revised Guidelines for Delivery of BH Services Through Telehealth (eff. 7/1/2022)](https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/docs/documents/omhsas/Bulletin%20OMHSAS-22-02%20-%20Revised%20Guidelines%20for%20Delivery%20of%20BH%20Services%20Through%20Telehealth%207.1.22.pdf)
19. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes](https://www.ecfr.gov/current/title-42/section-438.210)
20. [10 U.S.C. 1079(i)(1) — TRICARE pays after other coverage except Medicaid](https://www.govinfo.gov/content/pkg/USCODE-2023-title10/html/USCODE-2023-title10-subtitleA-partII-chap55-sec1079.htm)
21. [OMHSAS IBHS Frequently Asked Questions (updated February 2022)](https://www.pa.gov/content/dam/copapwp-pagov/en/dhs/documents/healthchoices/hc-providers/documents/intensive-behavioral-health-services-(ibhs)/ibhs-faq-updated-02-22-22.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.