---
title: "NH Healthy Families ABA coverage: the intake guide."
url: "https://carelu.com/payers/nh-healthy-families"
markdown_url: "https://carelu.com/payers/nh-healthy-families.md"
state: NH (New Hampshire)
payer: NH Healthy Families
kind: Medicaid managed care plan (MCO)
parent_program: New Hampshire Medicaid (Medicaid Care Management)
description: "How NH Healthy Families (Centene) covers ABA for New Hampshire Medicaid members: the behavioral health billing platform and payer ID, prior authorization, the codes it pays, turnaround, and what intake should collect."
last_reviewed: September 2026
---

# NH Healthy Families ABA coverage: the intake guide.

_Payer Guide · NH Healthy Families · New Hampshire · Last updated September 2026 · 8 primary sources_

> Centene’s NH Medicaid plan: ABA runs on the behavioral health platform (payer ID 68068) with PA via OTR form or portal.

NH Healthy Families is Centene’s New Hampshire Medicaid plan (underwritten by Granite State Health Plan, Inc.) and one of the three plans DHHS lists. Its ABA rules are spread across three documents: a 2019 payment policy that set the codes and kept prior authorization, a 2024 tip sheet that moved ABA onto the behavioral health platform, and the January 2026 provider manual that sets the decision clock.

This plan administers the **New Hampshire Medicaid (Medicaid Care Management)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [New Hampshire Medicaid guide](https://carelu.com/payers/new-hampshire-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment:** Not published / unverified. Verify via: NH Healthy Families Medicaid Pre-Auth Check (enter 97151) or Utilization Management, 1-866-769-3085. [1][4]
- **Prior auth for treatment**: Yes. "ABA treatment must be billed under the qualified rendering provider and will continue to require prior authorization" (NH.PP.07); request it on the Outpatient Treatment Request form or the behavioral health portal [1][2]
- **Autism diagnosis required?**: Yes. The plan publishes no ABA diagnosis rule of its own, so the state rule applies: ABA "for individuals with" autism spectrum disorder or pervasive developmental disability (He-W 589.04(ag)) [1][6]

## At a glance

- **Covers ABA?:** Yes, for NH Medicaid members (EPSDT, under 21)
- **Treatment PA:** Required (NH.PP.07); Outpatient Treatment Request form or BH portal
- **Claims:** Behavioral health platform, payer ID 68068, for dates of service from 6/1/2024
- **Codes paid (NH.PP.07):** 97151 assessment (up to 32 units), 97153, 97155, 97156; no bundled H2019
- **Decision clock:** 7 calendar days standard, 72 hours expedited
- **Licensure:** None in NH; BACB certification governs

## Codes, prior authorization and the behavioral health platform

Payment policy NH.PP.07 (effective May 1, 2019) ended the old bundled H2019 rate and pays ABA in "three (3) distinct components of ABA therapy: direct treatment, supervision, and parent training": 97153 direct treatment, 97155 supervision of a technician, 97156 parent training, plus 97151 for the initial assessment or reassessment, whose maximum rose "from 8 units (2 hours) to 32 units (8) hours." The same policy says "ABA treatment must be billed under the qualified rendering provider and will continue to require prior authorization." [1][2]

Since June 1, 2024, ABA is adjudicated on the behavioral health platform: Medicaid ABA claims go to payer ID 68068 (Ambetter marketplace ABA to 68069). Prior authorization goes on the Outpatient Treatment Request form or through the behavioral health portal, and new ABA providers enroll with the Behavioral Health Provider Specialty Profile. Existing authorizations were converted without re-authorization. [1][2]

## Intake gates

The questions that decide whether a family can start with NH Healthy Families, and what they have to bring.

- **Age limit**: Under 21. The plan covers ABA within NH Medicaid’s EPSDT benefit, which covers members under 21 (He-W 546.02); it publishes no different age rule. [6][1]
- **Referral required?**: The plan publishes nothing different from the state, where ABA must be "recommended by a licensed clinician who has experience in the diagnosis and treatment of autism spectrum disorder" (physician, psychologist, or developmental-medicine NP or PA; He-W 589.04(aj)). [1][6]
- **Prior-auth decision time**: Standard requests: "the decision and notification will be made no more than seven (7) calendar days from receipt of the request (unless an extension is requested)." Urgent pre-service requests: 72 hours. Supply clinical information promptly: "Failure to submit necessary clinical information within forty-eight (48) hours of the request can result in an administrative denial." Routine requests should go in "at least five calendar days before the scheduled service delivery date"; out-of-network requests need 10 calendar days. [3][7]
- **Other insurance (who pays first)**: "NH Healthy Families is always the payer of last resort." Providers must make reasonable efforts to identify other coverage (individual, group, employer, self-funded or commercial) and tell the plan if the family won’t cooperate. If other coverage is found after services, the plan "will coordinate with the provider to pay any claims that may have been denied for payment due to third party liability." [3][8]
- **Diagnosis recency** _(ask the plan)_: Not stated by the plan or the state. [1]
  - Ask the plan: NH Healthy Families Utilization Management, 1-866-769-3085.
- **Diagnostic tools required** _(ask the plan)_: Not stated by the plan or the state. [1]
  - Ask the plan: NH Healthy Families Utilization Management, 1-866-769-3085: ask which instruments it expects with the OTR.
- **Telehealth** _(ask the plan)_: The plan’s ABA documents set no telehealth rule. [1][3]
  - Ask the plan: NH Healthy Families Provider Services, 1-866-769-3085: ask which ABA codes are payable by telehealth and with which POS code.

## Delivery and billing rules

Coverage decides whether NH Healthy Families 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**: NH.PP.07 treats 97155 as "Supervision of a Technician" but sets no ratio, and the plan publishes no other supervision rule. The state rule applies: a BCBA with BACB supervisory certification supervises BCaBAs, RBTs and rehabilitation assistants, with no numeric ratio (He-W 589.04(ah)). [1][6]
- **Daily limits / MUEs**: The only published unit limit is on the assessment: 97151 initial assessment or reassessment up to 32 units (8 hours), raised from 8 units in line with BACB guidance and CMS medically unlikely edits. Treatment units are set by the authorization. [1]
- **Bill as provider**: "ABA treatment must be billed under the qualified rendering provider" (NH.PP.07). ABA claims go to the behavioral health platform, payer ID 68068 for Medicaid. [1][2]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed. NH.PP.07 lists 97153 and 97155 as separate components without saying whether they may be billed for the same clock time. [1]
  - Ask the plan: NH Healthy Families Provider Services, 1-866-769-3085, or your Provider Engagement Account Manager.
- **Session-note signature** _(ask the plan)_: NH.PP.07 states "Documentation Requirements: Not Applicable," and the provider manual publishes no ABA session-note rule. [1][3]
  - Ask the plan: NH Healthy Families Provider Services, 1-866-769-3085, or the documentation terms in your provider agreement.
- **Place of service** _(ask the plan)_: The plan publishes no ABA setting rule. At the state level, school-based ABA is billed by school districts under the Medicaid to Schools program (He-W 589). [1][6]
  - Ask the plan: NH Healthy Families Provider Services, 1-866-769-3085: ask which place-of-service codes it pays for ABA.

## What intake should collect for NH Healthy Families

- **Member ID:** Confirm Medicaid (not the Ambetter marketplace product, which uses a different payer ID).
- **Diagnosis:** Autism spectrum disorder or PDD.
- **Treatment plan for the OTR:** Direct treatment, supervision and parent-training hours, which map to 97153, 97155 and 97156.
- **Other insurance:** The plan is payer of last resort; tell it if the family won’t help identify other coverage.

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

## Common questions

### Does NH Healthy Families cover ABA?

Yes, for New Hampshire Medicaid members. It pays 97151, 97153, 97155 and 97156 and requires prior authorization for ABA treatment.

### Where do I send NH Healthy Families ABA claims?

To the behavioral health platform: payer ID 68068 for Medicaid, for dates of service on or after June 1, 2024.

### How fast does NH Healthy Families decide an ABA authorization?

Within 7 calendar days for standard requests and 72 hours for urgent ones, per its January 2026 provider manual.

## Primary sources

1. [NH Healthy Families Payment Policy NH.PP.07 — Applied Behavioral Analysis (eff. 5/1/2019)](https://www.nhhealthyfamilies.com/content/dam/centene/NH%20Healthy%20Families/Medicaid/pdfs/Applied-Behavioral-Analysis-Policy-NH-PP-07.pdf)
2. [NH Healthy Families — Transition of ABA Services to Behavioral Health Platform, Billing Tip Sheet (eff. 6/1/2024)](https://www.nhhealthyfamilies.com/content/dam/centene/NH%20Healthy%20Families/Medicaid/pdfs/NHHF_Ambetter_ABA_Transition.pdf)
3. [NH Healthy Families — Provider Manual (January 2026)](https://www.nhhealthyfamilies.com/content/dam/centene/NH%20Healthy%20Families/Medicaid/pdfs/NHHF_Provider_Manual_January_2026_CLEAN_version.pdf)
4. [NH Healthy Families — Medicaid Pre-Auth Check (code lookup)](https://www.nhhealthyfamilies.com/providers/preauth-check/medicaid-pre-auth.html)
5. [NH DHHS — Medicaid Care Management (the three Medicaid health plans)](https://www.dhhs.nh.gov/programs-services/medicaid/medicaid-care-management)
6. [N.H. Admin. Rules He-W 500 — Medical Assistance (He-W 506, 530, 546 EPSDT, 589 Medicaid to Schools)](https://www.gencourt.state.nh.us/rules/state_agencies/he-w500.html)
7. [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)
8. [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)

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.