Partners Health Management, a Tailored Plan, adopts NC's clinical coverage policies outright for medical-necessity decisions — 8F included — and runs the most provider-friendly authorization model in the state: since October 2023, RB-BHT authorizations issue as "ALL codes," meaning one authorization on the base code covers every RB-BHT service code and modifier combination, telehealth included. The flexibility is real; so is the caveat that billing outside the approved treatment plan risks recoupment.
Partners' own website now opens with: "Vaya Health and Partners Health Management officially merged on October 1, 2026, to become Vaya Partners," and calls itself "a legacy website" where "certain forms and resources may remain available" during the transition. NCDHHS's LME/MCO directory now lists Vaya Partners Health, not Partners, alongside Alliance and Trillium.[19][20][2][5][21]
For an ABA provider the merged plan's rules now govern: "Vaya Partners network providers must submit service authorization requests (SARs) electronically through the Vaya Partners ProviderCONNECT," and the binding rulebook is the Vaya Partners Provider Operations Manual v1.0 (Oct. 1, 2026), which replaces the 2025-2026 Partners manual. UM is UM@VayaPartners.org or 1-800-893-6246, ext. 1515 (behavioral health); provider support is 1-866-990-9712. The Partners-specific practices below (the ALL-codes authorization in ProAuth) come from legacy Partners documents; Vaya Partners has not said whether it keeps them, so ask UM before relying on them.[19][20][2][5][21]
Instead of code-by-code authorizations, Partners issues one authorization covering all RB-BHT codes and modifiers: submit via ProAuth entering the base code as the Primary Procedure Code on the Prescreen and selecting the Treatment Type from the dropdown; authorizations are then visible in both ProAuth and Alpha. Operationally this means clinical teams can flex between assessment, direct treatment, supervision, and parent training without new requests — but every billed unit must still trace to the approved treatment plan, because Partners pairs the flexibility with post-payment review and recoupment for out-of-plan billing.[9][8][10][6]
Partners also runs an Autism Services Learning Collaborative for its network ABA providers, and its Tailored Plan documentation cross-references Carolina Complete Health policies through a Centene infrastructure partnership.[9][8][10][6]
Code set: like every NC Medicaid plan, this one pays RB-BHT only under the CPT codes in CCP 8F Attachment A, 97151–97157, in 15-minute units. 97158, 0362T and 0373T are not covered, and no HCPCS H-code (H0031, H0032, H2014, H2019) is an RB-BHT code. The plan publishes no different code list. 96112 (developmental testing) is likewise not an RB-BHT code; NC Medicaid’s billing guidance lists it among procedure codes shared by physical and behavioral health.[9][8][10][6]
Closed. Partners' provider alert of July 8, 2026 (updated July 13): under S.L. 2026-41, RB-BHT and peer support "will transition to closed network services. This means that participation in the delivery of these services will be limited to contracted providers within the approved network."[11][12]
Providers already delivering RB-BHT "should continue operating as contracted and approved." For newcomers: "Partners will evaluate new requests to provide RB-BHT and PSS on a case-by-case basis against our selection criteria, which includes a network need." Questions go to CredentialingTeam@partnersbhm.org.[11][12]
North Carolina licenses the practice itself: “it shall be a violation of this Article for any individual not licensed under this Article to practice behavior analysis” (G.S. 90-746(a); a Class 2 misdemeanor under 90-746(b)), with exemptions for NC-licensed psychologists and for behavior technicians working under a licensed professional’s direction (G.S. 90-745). An analyst licensed elsewhere has two routes: a temporary license for one who “resides and practices behavior analysis in another state,” available “only if the behavior analysis services are to be delivered during a limited and defined period of service approved by the Board” (G.S. 90-740), and licensure by reciprocity for someone actively licensed in a state with comparable requirements that reciprocates with North Carolina (G.S. 90-741). Article 43 contains no telehealth exception, so plan on an NC license before treating a child located in North Carolina by video.[13][14][15][16]
For NC Medicaid the answer is now no for a new enrollee. Session Law 2026-1 added G.S. 108C-9(e): “Board Certified Behavior Analysts and Qualified Autism Services Practitioner Supervisors shall not be permitted to enroll in the North Carolina Medicaid program as out-of-state providers,” applying to enrollment applications submitted on or after the law took effect. NC Medicaid’s August 31, 2026 reminder restates it: all LQASPs and C-QPs, “including Board Certified Behavior Analysts and Board Certified Assistant Behavior Analysts, seeking to enroll in the NC Medicaid program must do so as an in-state provider,” effective August 2, 2026.[13][14][15][16]
Federal rules make the state Medicaid enrollment rule binding on the plan: the state “must screen and enroll, and periodically revalidate, all network providers” of Medicaid managed care plans (42 CFR 438.602(b)(1)). So a BCBA in Partners Health Management’s network has to be enrolled with NC Medicaid as well.[13][14][15][16]
NC Medicaid’s rule binds the plans: CCP 8F (amended 8/1/2026) requires prior approval before RB-BHT services, says services provided without prior authorization “are not considered for payment or reimbursement except in the case of retroactive Medicaid eligibility,” and lists “services provided without prior authorization by the PHP” among the services Medicaid does not cover.[10][5]
Since the October 1, 2026 merger the Vaya Partners manual governs, and it allows a retrospective request only for late eligibility: "If a member did not have Medicaid at the time the service was provided but later gains eligibility that covers the dates of service, providers may request retrospective authorization by submitting the SAR and all documentation no later than 90 days following the notification of the Medicaid eligibility determination."[10][5]
NC Medicaid sets the floor for every Tailored Plan and LME/MCO, Partners Health Management included. Its prompt-payment fact sheet gives Tailored Plans a 365-day timely filing window from July 1, 2024. NC Medicaid Direct claims the LME/MCOs process also moved from 90 to 365 days on July 1, 2024. The window covers the original claim and any corrected claim. State-funded services must be filed within 90 calendar days.[17][4][3][5][6][1]
Within 18 calendar days of receiving a medical claim the plan must say whether it is clean or pend it for more information. It must pay or deny a clean claim within 30 days, and deny the claim if requested information has not arrived within 90 days. Late payment carries 18% annual interest.[17][4][3][5][6][1]
Since the October 1, 2026 merger, legacy Partners claims run on the Vaya Partners schedule. Weekly cutoff: “Vaya Partners adheres to the standardized LME/MCO checkwrite schedule, which is based on a 5 p.m. Tuesday cutoff. Claims received before this cutoff date will be paid the following week according to the checkwrite schedule.” In the 2026 schedule (rev. 9/30/2026), claims posted Wednesday through Tuesday go into a check run the following Monday, with payment dated that Thursday. For example, claims posted 1/28–2/3/2026 ran on 2/9 and were paid 2/12. Holiday weeks shift by a day. The manual encourages providers to bill “on a weekly or bimonthly schedule” to match it.[17][4][3][5][6][1]
EVV does not apply to RB-BHT: NC Medicaid’s billing guidance lists the services “subject to EVV for Managed Care” as Personal Care, Home Health, Innovations Waiver, TBI and 1915(i) services (§3.52).[17][4][3][5][6][1]
Taxonomy: the plan must “validate the taxonomy code submitted on the claim” against the provider’s NC Medicaid enrollment record and “price claims based on the taxonomy code submitted on the claim” (billing guidance §3.22), so bill the taxonomy you are enrolled under in NCTracks. The Vaya Partners manual: “Accurate NPI numbers and taxonomy codes are required for claims to be accepted and processed,” and they must “exactly match the information in NCTracks,” or the claim is denied or recouped.[17][4][3][5][6][1]
Referring or ordering NPI: not required on an RB-BHT claim. NC Medicaid’s OPR guidance lists the claim types that need an ordering NPI (home infusion, private duty nursing, labs, IDTF, CAP, radiology, DME, LEA) or a referring NPI (home infusion, specialized therapy, hospice, home health, PDN, dialysis, CAP, LEA), and RB-BHT is not on either list. The physician or psychologist who signs the service order must still be enrolled in NC Medicaid (42 CFR 455.410).[17][4][3][5][6][1]
The questions that decide whether a family can start with Partners Health Management (NC Tailored Plan), and what they have to bring. Each maps onto something intake should ask on the first call.
Follows the NC Medicaid rule: CCP 8F carries no upper age bound (the 8/1/2026 rewrite removed "under 21 years of age" from the eligibility provision), under-21 members carry the EPSDT special provision, and beneficiaries under three may start on a provisional diagnosis.[10][9]
Follows the NC Medicaid rule: no expiry on the ASD diagnosis itself, but a provisional under-3 diagnosis must become non-provisional within six months, an adaptive behavior assessment must be under 3 years old, and diagnostic documentation must be verified and on file before services start.[10][9]
Follows the NC Medicaid rule: a non-provisional ASD diagnosis comes from a Licensed Psychologist, a supervised Licensed Psychological Associate, or a physician (MD or DO); a Licensed School Psychologist evaluation may be used where the required testing is included; a provisional under-3 diagnosis may also come from a trained master’s-level licensed clinician within scope.[10][9]
Follows the NC Medicaid rule: the ASD diagnosis must use BOSA, Tele-ASD-Peds, ADOS-2, or CARS2-ST/CARS2-HF; screeners, educational determinations and informal impressions cannot start services. The packet also needs a skills assessment (VB-MAPP, ABLLS-R or ESDM Curriculum Checklist), an FBA where challenging behaviors are targeted, and an adaptive behavior assessment within 3 years (VABS-3, ABAS-3 or DP-4).[10][9]
Follows the NC Medicaid rule: a service order signed and dated by a Licensed MD, DO or Licensed Psychologist, in place on or before the first date of service, based on a behavioral/adaptive/functional assessment and treatment plan, valid one year and re-ordered annually. 97151 and 97152 need no service order for prior approval; 97153–97157 do.[10][9]
Follows the NC Medicaid rule (Attachment A, eff. 8/1/2026): GT telehealth is billable for 97151 with clinical justification and for 97155 up to 50% of total 97155 billing per beneficiary per 180 days; telehealth is removed entirely for 97152, 97153 and 97154; 97156 and 97157 remain telehealth eligible and are the only KX telephonic services, on a documented caregiver health or access barrier. NC Medicaid’s billing guidance binds the plan to the same edit: “Claims submitted with Modifier GT (Telehealth) for 97152 - 97154 are not reimbursable and should be denied” (v36 §3.54.1). Telehealth claims carry the provider’s usual place-of-service code (8F Attachment A), and 8F does not require the telehealth modality to be named on the authorization.[10][9][6]
Since the October 1, 2026 merger, Vaya Partners' manual (v1.0) governs: "For standard reviews, Vaya Partners will issue a decision within seven (7) calendar days," extendable "up to fourteen (14) additional days," and requests meeting expedited criteria are reviewed "within 72 hours." Submit a SAR "at least seven (7) calendar days prior to the requested service start date" (concurrent requests seven calendar days before the current authorization ends; the prior-authorization page caps lead time at 30 days), and answer any request for more information within one business day or the SAR is returned "unable to process." The 2025-2026 Partners manual it replaces allowed 14 calendar days plus a 14-day extension. CCP 8F requires the RB-BHT reauth before the current authorization expires.[5][2][22][23][24][10]
Since the October 1, 2026 merger the Vaya Partners manual (v1.0) governs: "Medicaid is the payor of last resort." Collect all first- and third-party funds before billing Vaya Partners, wait a reasonable time for the other payer, keep its RA/EOB or other proof of payment or denial, and bill only the remaining amount; such claims are due within 180 days of the other payer's remittance, and where the member also uses state-funded services, state funds pay last. Under the legacy Partners manual, Partners would "not pay for any service that could have been paid for by Medicare or other private insurance plans had the member or provider complied with the plan's requirements" — so follow the commercial plan's ABA precert rules to the letter. Neither manual says whether the plan's own prior authorization is still needed when it pays second; CCP 8F requires prior approval before rendering RB-BHT and carves out no exception for members with other insurance, so get the plan’s authorization on file unless the plan confirms in writing that it is waived. Under federal rules TRICARE pays before Medicaid and CHAMPVA pays first when the child is also Medicaid-eligible.[5][22][10][25][26]
Coverage decides whether Partners Health Management (NC Tailored Plan) 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.
Follows the NC Medicaid rule: at least 10% of paraprofessional-delivered services must involve LQASP observation and direction, and above 200 paraprofessional hours per 180 days the LQASP-to-paraprofessional ratio must sit between 10% and 20%, documented in the treatment plan with deviations clinically justified. Incidental supervision is not billable. Neither CCP 8F nor the Vaya Partners manual (v1.0) caps how many paraprofessionals one LQASP may supervise; the limits are the per-beneficiary 10% floor and 10–20% band.[10][9]
Follows the NC Medicaid rule: 97153 or 97154 may be billed concurrently with 97155 when a paraprofessional delivers the direct service under an eligible provider’s observation, but a single rendering provider may not bill 97153/97154 and 97155 simultaneously. 97151, 97152, 97156 and 97157 allow no concurrent billing, and non-RB-BHT services may not be billed for the same clock time. Follows the NC Medicaid rule here too. ABA alongside speech, occupational or physical therapy: Policy 8F (amended 8/1/2026) §4.2.1(n) does not cover "non-RB-BHT Medicaid services billed at the same time as RB-BHT service (as reflected in the session note …). Same-day delivery is allowable." So a speech, OT or PT visit may fall on the same day as ABA, but not on the same clock time as a billed RB-BHT session — and the session note, which must record session time in and out (§5.5.1), is what shows the two did not overlap. §4.1(c) separately excludes any service that duplicates another provider's service.[10][9]
Two different ceilings. Per day, a claim edit: since the October 1, 2026 merger, the Vaya Partners Provider Operations Manual (v1.0, Oct. 1, 2026) says Vaya Partners "uses National Correct Coding Initiative (NCCI) edits and Medically Unlikely Edits (MUE) during adjudication to validate claims," as NC Medicaid’s billing guidance requires of every health plan (§3.6.2). The public CMS Medicaid NCCI practitioner MUE table for dates of service 10/1–12/31/2026 sets these maxima per beneficiary per date of service: 97151 32 units, 97152 16, 97153 32 (8 hours), 97154 18, 97155 24, 97156 16, 97157 16, 97158 16, 0362T 16 and 0373T 32. Units above the MUE on one date of service deny as a claim edit whatever the authorization allows; the authorization, not the MUE, is the real weekly limit. Per authorization period, the NC Medicaid rule (CCP 8F sets no per-day cap of its own). Legacy Partners’ own model is unusually permissive on codes: since October 2023 one authorization on the base code covers every RB-BHT code and modifier combination, telehealth included, submitted through ProAuth with the base code as Primary Procedure Code on the Prescreen. The flexibility is paired with post-payment review — every billed unit must trace to the approved treatment plan or face recoupment.[10][9][5][6][7]
Follows the NC Medicaid rule: the staff member who delivered the service signs the note with credentials (professional) or job title (paraprofessional), and an LQASP or C-QP is not required to countersign a note written by non-LQASP/C-QP staff. A full note is required per contact per date of service with the elements listed in 8F subsection 5.5.1, and the treatment plan is signed and dated by the LQASP and the consenting party before services begin.[10][9]
Follows the NC Medicaid rule: clinic, home, school and community settings are all payable in any combination, individually justified and documented in the treatment plan, with the goal of advancing toward natural settings. IDEA-duplicative school services are excluded, and telehealth or telephonic claims carry the provider’s usual place-of-service code.[10][9]
Follows the NC Medicaid rule on rendering-provider eligibility, the professional claim and the 120-day RBT/ABAT certification clock. Partners issues authorizations as "ALL codes" on the base code, so the claim’s code and modifier can flex within the approved treatment plan without a new request — but billing outside that plan is recouped.[10][9][9]
Yes — as a Tailored Plan it adopts CCP 8F for RB-BHT medical-necessity decisions, with prior authorization required per the state baseline.
Since October 2023, one Partners authorization on the base code covers all RB-BHT codes and modifiers — no code-by-code requests. Billing must still match the approved treatment plan or risk recoupment.
Partners merged into Vaya Partners on October 1, 2026, and Vaya Partners network providers must submit SARs electronically through its ProviderCONNECT portal (UM: UM@VayaPartners.org, (800) 893-6246 ext. 1515). Legacy Partners used ProAuth, with the base code as the Primary Procedure Code on the Prescreen.
Closed. Partners limits RB-BHT to contracted providers in its approved network; current providers continue as contracted, and new requests are reviewed case by case against selection criteria that include network need. Email CredentialingTeam@partnersbhm.org.
Partners applies CCP 8F, which does not say an authorization transfers. CCP 8F treats needing "a different RB-BHT provider agency" as a transition or discharge reason, requires the Treatment Plan to be reviewed on a change in service provider, and will not pay two providers for duplicate services. Expect the new agency to submit its own request, and confirm with Partners utilization management.
North Carolina requires an NC license to practice behavior analysis (G.S. 90-746), with no telehealth exception; temporary and reciprocity licenses exist (G.S. 90-740, 90-741). NC Medicaid no longer enrolls BCBAs as out-of-state providers (G.S. 108C-9(e)), and plan network providers must be enrolled with the state (42 CFR 438.602(b)(1)).
Only for retroactive Medicaid eligibility: under the Vaya Partners manual (in force since the October 1, 2026 merger), submit the SAR and all documentation no later than 90 days after the eligibility determination notice.
365 days from the date of service for Tailored Plan and NC Medicaid Direct claims since July 1, 2024, corrected claims included, under NC Medicaid’s rule for LME/MCOs. State-funded services are 90 days. Clean claims must be paid or denied within 30 days.
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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