---
title: "Molina Healthcare of Washington ABA coverage: the intake guide."
url: "https://carelu.com/payers/molina-healthcare-washington"
markdown_url: "https://carelu.com/payers/molina-healthcare-washington.md"
state: WA (Washington)
payer: Molina Healthcare of Washington
kind: Medicaid managed care plan (MCO)
parent_program: Washington Apple Health (HCA)
description: "How Molina Healthcare of Washington covers ABA for Apple Health members: the state COE pathway, prior authorization through Molina’s lookup tool, group-level authorizations, credentialing for BCBAs vs. CBTs and LABAs, contacts and what intake should collect."
last_reviewed: October 2026
---

# Molina Healthcare of Washington ABA coverage: the intake guide.

_Payer Guide · Molina Healthcare · Washington · Last updated October 2026 · 11 primary sources_

> Apple Health MCO: PA "typically required" for ABA (check the lookup tool), granted at the group level; BCBAs credentialed individually, CBTs and LABAs rostered.

Molina Healthcare of Washington is one of the five Apple Health managed care plans HCA lists. It covers ABA under the state’s chapter 182-531A WAC pathway. What we could confirm about Molina’s own process comes from its slides in HCA’s February 2025 ABA technical assistance session; Molina’s Washington Medicaid provider pages and documents now return the company’s new-site "Page Not Found" page, so anything Molina-specific beyond that is marked "confirm with Molina."

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

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment:** Not published / unverified. Verify via: Molina Prior Auth Look-up Tool (Availity) or Molina behavioral health UM; general ABA questions to aba@molinahealthcare.com: check 97151. [3]
- **Prior auth for treatment** _(plan-dependent)_: "Prior Authorization (PA) is typically required for ABA services," and "PA is generally granted at the Group level, so anyone affiliated under the group can render the service" (Molina, HCA ABA session, February 2025). Confirm each code in Molina’s lookup tool [3][5]
  - Blocked on: Molina Prior Auth Look-up Tool or Provider Services, (855) 322-4082.
- **Autism diagnosis required?**: Yes. The Apple Health rule binds every MCO: a COE-confirmed ASD or other developmental/intellectual disability for which ABA is effective (WAC 182-531A-0400), and HCA applies the COE requirement "whether the client is fee-for-service or enrolled in a managed care organization." Molina’s own ABA criteria could not be read this run [5][6]

## At a glance

- **Covers ABA?:** Yes, for Apple Health members, under WAC 182-531A (COE evaluation required)
- **Prior auth:** "Typically required"; check codes in Molina’s Prior Auth Look-up Tool
- **Authorization level:** Generally granted to the group, so any affiliated clinician can render
- **Credentialing:** BCBAs individually credentialed; CBTs and LABAs added to the group by roster or mini-application
- **Contacts:** ABA questions aba@molinahealthcare.com; member ABA line 509-321-1365; Provider Services (855) 322-4082

## What Molina told providers about ABA

At HCA’s February 27, 2025 ABA technical assistance session, Molina said: "Prior Authorization (PA) is typically required for ABA services. Please utilize Molina’s Prior Auth Look-up Tool to determine if PA is needed. PA is generally granted at the Group level, so anyone affiliated under the group can render the service." "BCBAs must be individually credentialed with Molina of Washington," while "CBTs and LABAs DO NOT need to be individually credentialed" and are added to the group by a mini-application or a roster sent to mhwproviderinfo@molinahealthcare.com. Contracting requests go to MHWProviderContracting@MolinaHealthcare.com with a W-9; claims go through Availity or a clearinghouse, and claim disputes through Availity. Molina’s autism case management team (four BCBA case managers) takes referrals at MHWCMReferrals@molinahealthcare.com, and general ABA questions go to aba@molinahealthcare.com or 1-800-869-7175. [3][5][6]

The rest of the pathway is the state’s: a Center of Excellence evaluation and prescription, an LBAT assessment and treatment plan, and prior authorization before treatment (WAC 182-531A-0500 to -0700). For MCO members the WAC says to "follow the managed care organization (MCO) process," and HCA requires every LBA, LABA and CBT to be enrolled as a servicing provider and listed on the group’s roster with each MCO. [3][5][6]

## Claim filing and payment rules at Molina

Federal Medicaid rules set the payment floor for every managed care plan: a state’s contract with an MCO "must provide that the organization will meet the requirements of § 447.45(d)(2) and (d)(3)" (42 CFR 447.46) — pay 90 percent of clean claims from practitioners within 30 days of receipt and 99 percent within 90 days — unless the plan and the provider agree in writing to an alternative schedule stipulated in the contract. A "clean claim" is one that "can be processed without obtaining additional information from the provider of the service or from a third party" (42 CFR 447.45(b)). Molina’s own Washington timely-filing, corrected-claim and secondary-claim limits sit in its Apple Health provider manual claims chapter, which returned a "Page Not Found" page when fetched for this guide; take them from your Molina agreement or Provider Services until it can be read. [1][2]

## Intake gates

The questions that decide whether a family can start with Molina Healthcare of Washington, and what they have to bring.

- **Who may diagnose**: A Center of Excellence, by state rule for all Apple Health members (WAC 182-531A-0800); a COE serving Molina members must also be contracted with Molina. A Center of Excellence: an individual provider, not a facility. Licensed under Title 18 RCW and experienced in diagnosing and treating ASD, a developmental pediatrician, neurologist, pediatric neurologist, pediatric psychiatrist, psychiatrist or psychologist qualifies whether or not they are on HCA’s COE list. ARNPs (including psychiatric mental health nurse practitioners), physicians, physician assistants and naturopaths qualify only after HCA’s COE training and designation, on a signed COE Attestation form HCA 13-0009 (WAC 182-531A-0800). HCA may, at its discretion, accept a non-COE evaluation, for example a recent evaluation paid by the child’s primary insurance. A COE serving an MCO member must also be contracted with that MCO. [5][6]
- **Diagnostic tools required**: By state rule: The COE documents "Results of formal diagnostic procedures performed by a provider, including name of measure, dates, and results, as available," or the clinical findings and observations used to confirm the diagnosis (WAC 182-531A-0500). The rule’s examples of ASD diagnostic tools are the ADI and the ADOS. If the COE has them, the evaluation must also include the ASD screening tool and date, a formal cognitive or developmental assessment with verbal, nonverbal and full-scale scores (examples: Mullen, Bayley, Wechsler) and a formal adaptive behavior assessment with domain scores (Vineland, ABAS), plus vision and hearing results. [5][6]
- **Referral required?**: By state rule, a COE prescription is required for every Apple Health member. Yes: a COE prescription. "Any person may refer a client" to a COE for an evaluation, including the PCP, a school or early intervention professional, the family or the MCO, though many COEs require a PCP referral and an MCO may require prior authorization for the COE evaluation. If the COE concludes ABA is appropriate it writes "a prescription for ABA services" and sends the evaluation and prescription to the chosen ABA provider or the family (WAC 182-531A-0500). The COE evaluation and order go in with the first PA request. [5][6]
- **Prior-auth decision time** _(plan-dependent)_: No Molina ABA timeframe could be read. Federal managed care rules apply: standard decisions "may not exceed 7 calendar days after receiving the request for service" for rating periods starting on or after January 1, 2026 (42 CFR 438.210(d)). [9]
  - Ask the plan: Molina behavioral health UM.

## Delivery and billing rules

Coverage decides whether Molina Healthcare of Washington 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.

- **Bill as provider**: The rendering clinician. Molina authorizes at the group level, but HCA requires each LBA, LABA and CBT to be enrolled with HCA, on the group roster sent to the MCO, and in the servicing provider box on claims for dates of service from July 1, 2025, with taxonomy 103K00000X in both taxonomy fields. [3][6]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed in any Molina source read; the state guide does not settle 97153/97155 overlap. [3][7]
  - Ask the plan: Molina Provider Services, (855) 322-4082, or your Molina provider agreement.
- **Daily limits / MUEs** _(ask the plan)_: No Molina unit limit could be read; units are set per authorization. [3]
  - Ask the plan: Molina behavioral health UM: ask whether HCA’s fee-schedule unit limits apply.

## What intake should collect for Molina Healthcare of Washington

- **Member ID:** Confirm Molina Apple Health (not Molina Marketplace or Medicare) on the date of service.
- **COE evaluation and prescription:** Required by the state rule for every Apple Health ABA request.
- **Group affiliation:** Molina authorizes at the group level: confirm the rendering clinicians are on the group’s Molina roster.
- **Other insurance:** Medicaid pays last; bill the commercial plan first.

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

## Common questions

### How fast must Molina Washington pay a clean ABA claim?

Its state contract must hold it to the federal Medicaid standard: 90% of clean practitioner claims paid within 30 days of receipt and 99% within 90 days (42 CFR 447.46, 447.45), unless the provider contract sets an alternative schedule. Its own filing limit comes from the provider manual or your agreement.

### Does Molina Healthcare of Washington require prior authorization for ABA?

Molina says PA is typically required and to check each code in its Prior Auth Look-up Tool. Authorizations are generally issued to the group, so any clinician affiliated with the group can render the service.

### Do CBTs and LABAs need to be credentialed with Molina?

No. Molina credentials BCBAs individually; CBTs and LABAs are added to the group by roster or mini-application. All must still be enrolled with HCA.

## Primary sources

1. [42 CFR 447.46 — Timely claims payment by MCOs (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-447/subpart-A/section-447.46)
2. [42 CFR 447.45 — Timely claims payment (clean-claim definition; 90% in 30 days, 99% in 90 days) (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-447/subpart-A/section-447.45)
3. [HCA — ABA Provider Technical Assistance webinar slides, with DOH and all five Apple Health MCOs (February 27, 2025)](https://www.hca.wa.gov/assets/billers-and-providers/aba-provider-technical-assistance-february-27-2025.pdf)
4. [HCA — Apple Health managed care (plan list and phone numbers)](https://www.hca.wa.gov/free-or-low-cost-health-care/i-need-medical-dental-or-vision-care/apple-health-managed-care)
5. [Chapter 182-531A WAC — Applied behavior analysis (Apple Health ABA rules: COE evaluation, stages, provider requirements, PA)](https://app.leg.wa.gov/wac/default.aspx?cite=182-531A&full=true)
6. [HCA — Washington Apple Health Applied Behavior Analysis (ABA) Program Billing Guide (January 1, 2026)](https://www.hca.wa.gov/assets/billers-and-providers/aba-services-bg-20260101.pdf)
7. [HCA — ABA Treatment Fee Schedule (effective July 1, 2026; last updated July 29, 2026)](https://www.hca.wa.gov/assets/billers-and-providers/aba-20260701.xlsx)
8. [HCA — Washington Apple Health Telemedicine Policy and Billing Guide (January 1, 2026)](https://www.hca.wa.gov/assets/billers-and-providers/telemedicine-policy-and-billing-bg-20260101.pdf)
9. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
10. [42 CFR 433.139 — Medicaid third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
11. [Molina Healthcare of Washington — Provider communications (Medicaid notices/bulletins and quarterly newsletters by year)](https://www.molinahealthcare.com/providers/wa/communications)

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.