---
title: "Meritain Health ABA coverage: the intake guide."
url: "https://carelu.com/payers/meritain-health"
markdown_url: "https://carelu.com/payers/meritain-health.md"
state: US (national)
payer: Meritain Health
kind: Commercial insurance
description: "Why a Meritain Health card is not a coverage answer: Meritain administers self-funded employer plans, so the employer's plan document decides ABA benefits and precertification, state autism mandates may not reach the plan, and verification runs per employer group."
last_reviewed: September 2026
---

# Meritain Health ABA coverage: the intake guide.

_Payer Guide · Meritain Health · Last updated September 2026 · 8 primary sources_

> Aetna-owned TPA for self-funded employer plans — the employer's plan document, not Meritain, sets the ABA benefit.

Meritain Health is a benefits administrator, not an insurer. It calls itself one of the nation's largest third-party administrators, a subsidiary of Aetna and CVS Health, serving self-funded employee benefit plans. That changes how intake should read the card: the employer funds the claims and writes the plan, including which services need precertification. The useful questions are which employer sponsors the plan and what that plan document says about ABA, not what Meritain's ABA policy is.

Two things follow. A self-funded ERISA plan is not treated as an insurer under state insurance law, so the state autism mandate a family has read about may not reach it. And two Meritain members can have different ABA benefits because they work for different employers. Verify each employer group separately.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment** _(plan-dependent)_: Plan-dependent — Meritain tells members to "consult your benefits guide" for which services need precertification; the employer plan sets the list [4][1]
  - Ask the plan: The employer's plan document, readable in the Meritain provider portal (account.meritain.com), or Meritain Medical Management at 1-800-242-1199 — ask whether 97151/97152 need precertification on this group.
- **Prior auth for treatment** _(plan-dependent)_: Plan-dependent — set by the employer's plan document and administered by Meritain; ask per group, never per carrier [4]
  - Ask the plan: The plan document in the Meritain provider portal, or Meritain Medical Management (1-800-242-1199) — ask whether ABA treatment codes need precertification and how requests are submitted for this group.
- **Autism diagnosis required?** _(plan-dependent)_: Plan-dependent — the diagnosis requirement is whatever the sponsor's plan document and adopted medical policy say; Meritain publishes no ABA policy of its own that we could find [1]
  - Ask the plan: The plan document (Meritain provider portal) — ask which medical-necessity criteria the plan applies to ABA and which diagnoses qualify.

## At a glance

- **What it is:** Third-party administrator for self-funded employer plans; a subsidiary of Aetna and CVS Health
- **Who sets the benefit:** The employer plan sponsor, in the plan document
- **Precert:** Plan-dependent; Meritain Medical Management 1-800-242-1199
- **State autism mandates:** May not apply; ERISA self-funded plans are not deemed insurers under state law
- **Network:** Sponsor's choice; over 90% offer Aetna Choice POS II, others use regional networks
- **Provider line:** Card number, or 1-800-566-9311 (24-hour automated benefits and claims)
- **Eligibility (EDI):** Optum (formerly Change Healthcare) or SSI; Availity for claim submission only

## A TPA card tells you who pays claims, not what is covered

A Meritain card tells you who processes the claim. It does not tell you what is covered. Meritain administers self-funded employee benefit plans, so the benefit design comes from the employer. Meritain's own precertification page tells members that "to read more about what services require precertification under your health care benefits plan, consult your benefits guide." Intake should capture the employer name and group number as first-class fields. [1][4][3]

The plan document is easier to get than it is on most TPA cards. Meritain's provider portal (account.meritain.com) lists "Plan documents" and "Eligibility and benefits" among what a registered provider can view, along with claims history, EOBs, the patient's ID card and accumulators. To register you need your tax ID, provider name and address exactly as on the W-9 you submitted, plus your NPI and phone number. For a new ABA family, read the plan document there before quoting coverage. [1][4][3]

## Settle the funding question before quoting a mandate

State autism mandates regulate insurance. Under ERISA's "deemer" clause, an employee benefit plan "shall [not] be deemed to be an insurance company or other insurer … for purposes of any law of any State purporting to regulate insurance companies, insurance contracts." In practice, a self-funded employer plan is generally outside the state mandate's direct reach, so the mandate a family cites for their state may not apply to their plan. Some sponsors still choose to cover ABA and some do not. The plan document is the only answer. [7][9]

There is one exception to watch for. ERISA "shall not apply" to governmental plans or to most church plans (29 U.S.C. § 1003(b)), so a city, county, school-district or church plan administered by Meritain is not an ERISA plan. Its rules come from its own plan terms and whatever state law reaches it. Ask who the employer is before relying on either framework. [7][9]

## The Aetna connection: the network, not the policy

Meritain says that "over 90 percent of our plan sponsors choose to offer the Aetna Choice POS II network" and that it is "the only TPA able to offer access to this network." It also offers regional and combined networks, so the network is a sponsor choice too. Confirm which one this group uses before treating an Aetna-participating provider as in network. [5][10]

Network access is not clinical policy. Aetna's ABA precertification form GR-69017-4 (7-26) lists the plans it "applies to": Aetna plans, Innovation Health plans, Allina Health | Aetna and Banner | Aetna. Meritain is not on that list. Do not assume Aetna's CPB 0554 criteria or Aetna's precert workflow govern a Meritain member unless the plan says so. [5][10]

## Running eligibility on a Meritain card

Meritain's clearinghouse table lists which vendors handle which transactions. Optum (formerly Change Healthcare) and SSI (ClaimsNet) handle eligibility, claim status and claim submission. Availity handles claims submission only. An eligibility check routed through Availity is therefore the wrong channel for Meritain. For a person, call the toll-free number on the back of the patient's ID card, or 1-800-566-9311 for 24-hour automated benefits and claims information. [6][3]

## How Meritain Health works state by state

The clinical policy above is national, but three state-level layers change what a family's card actually buys: the state autism mandate (what fully-insured plans must cover), the carrier's state Medicaid plans (which follow the state Medicaid rules, not this commercial policy), and plan funding type (self-funded ERISA plans can carve benefits differently).

- **Georgia** (mandate: Ava’s Law (O.C.G.A. § 33-24-59.10)): fully-insured Meritain Health plans issued in Georgia sit under the state mandate. State Medicaid baseline: [Georgia Medicaid guide](https://carelu.com/payers/georgia-medicaid).
- **North Carolina** (mandate: N.C.G.S. § 58-3-192 (autism coverage)): fully-insured Meritain Health plans issued in North Carolina sit under the state mandate. State Medicaid baseline: [North Carolina Medicaid guide](https://carelu.com/payers/north-carolina-medicaid).
- **Indiana** (mandate: Indiana autism insurance mandate (IC 27-8-14.2)): fully-insured Meritain Health plans issued in Indiana sit under the state mandate. State Medicaid baseline: [Indiana Medicaid (IHCP) guide](https://carelu.com/payers/indiana-medicaid).
- **Virginia** (mandate: Virginia autism insurance mandate (§ 38.2-3418.17)): fully-insured Meritain Health plans issued in Virginia sit under the state mandate. For Medicaid members, Meritain Health operates [Aetna Better Health of Virginia](https://carelu.com/payers/aetna-better-health-virginia) (each covered by its own guide). State Medicaid baseline: [Virginia Medicaid (DMAS) guide](https://carelu.com/payers/virginia-medicaid).
- **Tennessee** (mandate: Tenn. Code Ann. § 56-7-2367 (neurological parity)): fully-insured Meritain Health plans issued in Tennessee sit under the state mandate. State Medicaid baseline: [TennCare (Tennessee Medicaid) guide](https://carelu.com/payers/tenncare-tennessee-medicaid).
- **Ohio** (mandate: Ohio autism insurance mandate (R.C. 3923.84)): fully-insured Meritain Health plans issued in Ohio sit under the state mandate. State Medicaid baseline: [Ohio Medicaid guide](https://carelu.com/payers/ohio-medicaid).
- **New Jersey** (mandate: P.L. 2009, c.115 (N.J.S.A. 17:48-6ii et al.)): fully-insured Meritain Health plans issued in New Jersey sit under the state mandate. For Medicaid members, Meritain Health operates [Aetna Better Health of New Jersey](https://carelu.com/payers/aetna-better-health-new-jersey) (each covered by its own guide). State Medicaid baseline: [NJ FamilyCare (New Jersey Medicaid) guide](https://carelu.com/payers/new-jersey-medicaid).
- **Maryland** (mandate: Habilitative services mandate (Md. Ins. § 15-835 + COMAR 31.10.39.03)): fully-insured Meritain Health plans issued in Maryland sit under the state mandate. State Medicaid baseline: [Maryland Medicaid (Medical Assistance) guide](https://carelu.com/payers/maryland-medicaid).
- **Colorado** (mandate: Colorado autism insurance mandate (C.R.S. § 10-16-104(1.4))): fully-insured Meritain Health plans issued in Colorado sit under the state mandate. State Medicaid baseline: [Health First Colorado (Colorado Medicaid) guide](https://carelu.com/payers/colorado-medicaid).
- **Utah** (mandate: Utah autism insurance mandate (Utah Code § 31A-22-642; caps removed 2020)): fully-insured Meritain Health plans issued in Utah sit under the state mandate. State Medicaid baseline: [Utah Medicaid guide](https://carelu.com/payers/utah-medicaid).
- **Arizona** (mandate: Steven’s Law (A.R.S. § 20-826.04; dollar caps repealed by SB 1590, 2025)): fully-insured Meritain Health plans issued in Arizona sit under the state mandate. For Medicaid members, Meritain Health operates [Mercy Care (AZ)](https://carelu.com/payers/mercy-care-arizona) (each covered by its own guide). State Medicaid baseline: [AHCCCS (Arizona Medicaid) guide](https://carelu.com/payers/arizona-ahcccs).
- **New York** (mandate: NY autism mandate (Ins. Law §§ 3216(i)(25), 3221(l)(17), 4303(ee))): fully-insured Meritain Health plans issued in New York sit under the state mandate. State Medicaid baseline: [New York Medicaid (NYS DOH / eMedNY) guide](https://carelu.com/payers/new-york-medicaid).
- **New Mexico** (mandate: New Mexico autism insurance mandate (NMSA 1978 § 59A-22-49)): fully-insured Meritain Health plans issued in New Mexico sit under the state mandate. State Medicaid baseline: [New Mexico Medicaid (Turquoise Care) guide](https://carelu.com/payers/new-mexico-medicaid).
- **Missouri** (mandate: Missouri autism insurance mandate (RSMo § 376.1224)): fully-insured Meritain Health plans issued in Missouri sit under the state mandate. State Medicaid baseline: [MO HealthNet (Missouri Medicaid) guide](https://carelu.com/payers/missouri-medicaid).
- **Texas** (mandate: Texas autism mandate (Tex. Ins. Code § 1355.015)): fully-insured Meritain Health plans issued in Texas sit under the state mandate. For Medicaid members, Meritain Health operates [Aetna Better Health of Texas](https://carelu.com/payers/aetna-better-health-texas) (each covered by its own guide). State Medicaid baseline: [Texas Medicaid (THSteps-CCP) guide](https://carelu.com/payers/texas-medicaid).
- **Massachusetts** (mandate: ARICA — Ch. 207, Acts of 2010 (M.G.L. c. 175 § 47AA et al.)): fully-insured Meritain Health plans issued in Massachusetts sit under the state mandate. State Medicaid baseline: [MassHealth (Massachusetts Medicaid) guide](https://carelu.com/payers/masshealth-massachusetts-medicaid).
- **Florida** (mandate: Steven A. Geller Autism Coverage Act (§ 627.6686, Fla. Stat.)): fully-insured Meritain Health plans issued in Florida sit under the state mandate. For Medicaid members, Meritain Health operates [Aetna Better Health of Florida](https://carelu.com/payers/aetna-better-health-florida) (each covered by its own guide). State Medicaid baseline: [Florida Medicaid — Behavior Analysis Services (AHCA) guide](https://carelu.com/payers/florida-medicaid).
- **Kansas** (mandate: Kansas autism insurance mandate (K.S.A. 40-2,194)): fully-insured Meritain Health plans issued in Kansas sit under the state mandate. State Medicaid baseline: [KanCare (Kansas Medicaid) guide](https://carelu.com/payers/kansas-medicaid).
- **Nebraska** (mandate: Neb. Rev. Stat. § 44-7,106 (autism coverage, 25 hr/wk cap)): fully-insured Meritain Health plans issued in Nebraska sit under the state mandate. State Medicaid baseline: [Nebraska Medicaid (Heritage Health) guide](https://carelu.com/payers/nebraska-medicaid).
- **Idaho** (mandate: No autism statute — DOI Bulletin 18-02 (habilitative-parity floor, plan years from 2019)): fully-insured Meritain Health plans issued in Idaho sit under the state mandate. State Medicaid baseline: [Idaho Medicaid guide](https://carelu.com/payers/idaho-medicaid).
- **Iowa** (mandate: Iowa autism mandates (Iowa Code §§ 514C.31, 514C.28; caps and age limits removed by H.F. 330 from 1/1/2026)): fully-insured Meritain Health plans issued in Iowa sit under the state mandate. State Medicaid baseline: [Iowa Medicaid (IA Health Link) guide](https://carelu.com/payers/iowa-medicaid).
- **Oklahoma** (mandate: Nick’s Law (36 O.S. § 6060.21; age and hour caps removed 2022)): fully-insured Meritain Health plans issued in Oklahoma sit under the state mandate. For Medicaid members, Meritain Health operates [Aetna Better Health of Oklahoma](https://carelu.com/payers/aetna-better-health-oklahoma) (each covered by its own guide). State Medicaid baseline: [Oklahoma Medicaid (SoonerCare / SoonerSelect) - Oklahoma Health Care Authority guide](https://carelu.com/payers/oklahoma-medicaid).
- **Michigan** (mandate: Michigan autism mandate (MCL 500.3406s, 550.1416e; through age 18, $50K/$40K/$30K caps allowed)): fully-insured Meritain Health plans issued in Michigan sit under the state mandate. State Medicaid baseline: [Michigan Medicaid guide](https://carelu.com/payers/michigan-medicaid).
- **Hawaii** (mandate: Luke’s Law (HRS § 431:10A-133; under 14, $25,000/yr ABA cap)): fully-insured Meritain Health plans issued in Hawaii sit under the state mandate. State Medicaid baseline: [Hawaii Medicaid (Med-QUEST / QUEST Integration) guide](https://carelu.com/payers/hawaii-medicaid).
- **California** (mandate: SB 946 autism mandate (H&S § 1374.73, Ins. Code § 10144.51; no age or dollar caps)): fully-insured Meritain Health plans issued in California sit under the state mandate. State Medicaid baseline: [Medi-Cal (California Medicaid) guide](https://carelu.com/payers/medi-cal-california-medicaid).
- **Pennsylvania** (mandate: Act 62 of 2008 (40 P.S. § 764h; under 21, CPI-adjusted cap $51,908 for 2026)): fully-insured Meritain Health plans issued in Pennsylvania sit under the state mandate. State Medicaid baseline: [Pennsylvania Medicaid (Medical Assistance) guide](https://carelu.com/payers/pennsylvania-medicaid).
- **New Hampshire** (mandate: RSA 417-E:2 autism coverage (HB 569, 2010; no age or dollar caps in current text)): fully-insured Meritain Health plans issued in New Hampshire sit under the state mandate. State Medicaid baseline: [New Hampshire Medicaid guide](https://carelu.com/payers/new-hampshire-medicaid).

## Intake gates

The questions that decide whether a family can start with Meritain Health, and what they have to bring.

- **Age limit** _(plan-dependent)_: Set by the plan document. Because a self-funded ERISA plan is generally outside state insurance mandates, a mandate's age band may not apply. A governmental or church plan is outside ERISA and has to be checked on its own terms. [7][9]
  - Ask the plan: The plan document in the Meritain provider portal — read any ABA age limit directly.
- **Referral required?** _(plan-dependent)_: Plan-dependent. Meritain's precertification guidance says the provider calls to precertify, reviewers check the treatment plan "against standard quality of care guidelines," and members should "consult your benefits guide" for which services need it. Whether ABA needs a physician referral or order, precertification, or neither is set by the group's plan. Medical Management: 1-800-242-1199. [4]
  - Ask the plan: The plan document in the provider portal, or Meritain Medical Management (1-800-242-1199) — ask whether ABA needs a referral, an order or precertification for this group.
- **Prior-auth decision time** _(plan-dependent)_: Meritain publishes no decision clock, so the governing law decides. For a self-funded ERISA plan, a pre-service claim is decided "not later than 15 days after receipt of the claim by the plan." That can be extended once "for up to 15 days" for matters beyond the plan's control. Urgent care is decided within "72 hours after receipt of the claim." Governmental and church plans are outside ERISA and follow their own plan terms. [8][9]
  - Ask the plan: Benefits verification: confirm the plan type (ERISA, governmental or church), and ask Meritain Medical Management how early a continued-service request may be filed.
- **Other insurance (who pays first)** _(plan-dependent)_: Between two commercial plans, including the birthday rule for a child covered by both parents, the order comes from the plan document's coordination-of-benefits terms, which Meritain administers but does not publish. Three federal rules hold regardless. Medicaid pays after other coverage: when third-party liability is established, the state "must reject the claim and return it to the provider." Congress intended "TRICARE be the secondary payer to all health benefit, insurance and third-party payer plans." CHAMPVA pays first only against Medicaid, IHS, state victims-of-crime programs and CHAMPVA supplements; otherwise "CHAMPVA will pay secondary." [11][12][13]
  - Ask the plan: The plan document's coordination-of-benefits section (Meritain provider portal), or the number on the ID card — ask the order-of-benefits rule for dependent children and the secondary-payment method.
- **Diagnosis recency** _(ask the plan)_: Not published by Meritain. Any rule on how recent the diagnostic evaluation must be comes from the medical policy the plan adopts. [4]
  - Ask the plan: Meritain Medical Management (1-800-242-1199) — ask whether an evaluation of this age is accepted before booking the assessment.
- **Who may diagnose** _(ask the plan)_: Not published by Meritain. Which credentials may make the ASD diagnosis depends on the plan's adopted ABA criteria. [4]
  - Ask the plan: Meritain Medical Management (1-800-242-1199) — ask which diagnosing credentials the group's ABA criteria accept.
- **Diagnostic tools required** _(ask the plan)_: Not published by Meritain. Whether a named instrument (ADOS-2 or similar) is required depends on the plan's adopted criteria. Collect the instrument, date and score anyway. [4]
  - Ask the plan: Meritain Medical Management (1-800-242-1199) — ask whether a specific diagnostic instrument is required for this group.
- **Telehealth** _(ask the plan)_: Not published by Meritain for ABA. Meritain's network page names telehealth among the care options on its Aetna networks, but whether any ABA code is payable by telehealth is a plan-document question. [5]
  - Ask the plan: Benefits verification on the specific group — ask which ABA codes, if any, are payable by telehealth and with which place-of-service code or modifier.

## Delivery and billing rules

Coverage decides whether Meritain Health 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** _(ask the plan)_: Nothing Meritain publishes sets a supervision requirement for ABA. Supervision terms come from the medical policy the plan sponsor adopts and the plan document, and they can differ between Meritain groups. [1]
  - Ask the plan: Meritain Medical Management (1-800-242-1199) or the plan document in the provider portal — ask which ABA medical policy the group applies and what it requires of BCBA supervision.
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not published by Meritain. Whether 97153 and 97155 may be billed for the same clock time depends on the plan's adopted payment and claim-editing rules. [3]
  - Ask the plan: The number on the back of the member's ID card — ask specifically whether 97153 and 97155 may overlap and which claim-editing rules the group uses.
- **Daily limits / MUEs** _(ask the plan)_: Not published by Meritain. Any hour, visit or dollar limit on ABA is written into the employer's plan document. [3]
  - Ask the plan: The plan document and accumulators in the Meritain provider portal — read any ABA limit and how much of it has already been used.
- **Session-note signature** _(ask the plan)_: Not published by Meritain. Documentation standards for ABA session notes are set by the plan's adopted medical policy and provider agreement. [3]
  - Ask the plan: The number on the member's ID card — ask which documentation standard applies at audit for this group.
- **Place of service** _(ask the plan)_: Not published by Meritain. Whether home, clinic, school or telehealth ABA is payable is a plan-document question for each employer group. [3]
  - Ask the plan: Benefits verification on the specific group — ask which places of service are payable for ABA and whether school-based delivery is excluded.
- **Bill as provider** _(ask the plan)_: Not published by Meritain. Whose NPI carries a technician-delivered 97153 claim, and which modifiers are required, depends on the network contract and the plan's billing rules. [6]
  - Ask the plan: The number on the member's ID card, plus the network the group uses (Aetna Choice POS II or a regional network) — confirm rendering-versus-billing NPI and modifiers before the first claim.

## What intake should collect for Meritain Health

- **Employer name and group number:** The benefit lives in the employer's plan document. Without the group, a Meritain benefit check has nothing to look up.
- **Plan type:** Self-funded ERISA, governmental or church plan? This decides whether ERISA's timelines and the state mandate apply. Never quote a mandate before this is known.
- **The plan document's ABA terms:** Coverage, precertification, hour or dollar limits and any age limit, read from the plan document in the Meritain provider portal.
- **Which network the group uses:** Most sponsors use Aetna Choice POS II, but some use regional networks. Confirm before treating Aetna participation as in network.
- **Member ID, card photo and the card's phone numbers:** Meritain tells providers to call the number on the back of the ID card, and the precertification number is often printed there too.
- **Other coverage:** The other parent's plan, Medicaid, TRICARE or CHAMPVA. The plan document's order-of-benefits terms and federal payer-order rules decide who pays first.

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

## Common questions

### Does Meritain Health cover ABA therapy?

It depends on the employer. Meritain administers self-funded employer plans, so the employer's plan document decides whether ABA is covered and whether it needs precertification. Meritain's own guidance tells members to consult their benefits guide. Registered providers can read the plan document in Meritain's provider portal.

### Is Meritain Health the same as Aetna?

No. Meritain is a subsidiary of Aetna and CVS Health, and most of its plan sponsors (over 90%, per Meritain) use the Aetna Choice POS II network. It administers employer-funded plans rather than insuring them, though, and Aetna's ABA precertification form does not list Meritain among the plans it applies to. Confirm the group's medical policy rather than assuming Aetna's.

### Does my state's autism mandate apply to a Meritain plan?

Often not directly. State autism mandates regulate insurance, and ERISA says a self-funded employer plan is not deemed an insurer for purposes of state insurance law. Governmental and church plans are outside ERISA and have to be checked separately. Find out the plan type before relying on a mandate.

## Primary sources

1. [Meritain Health — About us (self-funded employee benefit plans)](https://www.meritain.com/about-us/)
2. [Meritain Health — For providers (provider portal)](https://www.meritain.com/resources-for-providers-meritain-health-provider-portal/)
3. [Meritain Health — Provider services](https://www.meritain.com/about-us-self-funded-employee-benefit-plans/meritain-health-provider-services/)
4. [Meritain Health — What is precertification and why do I need it?](https://www.meritain.com/what-is-precertification-and-why-do-i-need-it/)
5. [Meritain Health — Network solutions](https://www.meritain.com/network-solutions/)
6. [Meritain Health — Electronic transaction vendors](https://www.meritain.com/about-us-self-funded-employee-benefit-plans/meritain-health-electronic-transaction-vendors/)
7. [29 U.S.C. § 1144 — ERISA preemption](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1144&num=0&edition=prelim)
8. [29 CFR § 2560.503-1 — ERISA claims procedure](https://www.ecfr.gov/current/title-29/subtitle-B/chapter-XXV/subchapter-F/part-2560/section-2560.503-1)
9. [29 U.S.C. § 1003 — ERISA coverage and exceptions (governmental and church plans)](https://uscode.house.gov/view.xhtml?req=granuleid:USC-prelim-title29-section1003&num=0&edition=prelim)
10. [Aetna — Outpatient BH ABA Treatment Request: Required Information for Precertification, form GR-69017-4 (7-26) (PDF)](https://www.aetna.com/content/dam/aetna/pdfs/aetnacom/pharmacy-insurance/healthcare-professional/documents/outpatient-behavioral-health-BH-ABA-assessment-precert.pdf)
11. [42 CFR § 433.139 — Medicaid payment of claims involving third party liability](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
12. [32 CFR § 199.8 — TRICARE double coverage](https://www.ecfr.gov/current/title-32/subtitle-A/chapter-VII/part-199/section-199.8)
13. [VA — CHAMPVA Guidebook (PDF)](https://www.va.gov/files/2025-12/CHAMPVA-Guidebook.pdf)

Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 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.