Partnership HealthPlan of California is the County Organized Health System for 24 northern counties — from Del Norte and Humboldt down through Marin, Sonoma, Napa, Solano and Yolo, and since 2024 Butte, Placer, Nevada, Sutter, Yuba and the rest of the northern valley — with about 847,000 Medi-Cal members in August 2026. In a COHS county there is no other Medi-Cal plan to choose, so every managed-care child there is a Partnership member. Mental health is delegated to Carelon Behavioral Health, but BHT is not: Partnership’s own Health Services Department reviews every BHT Treatment Authorization Request.
Policy MCUP3126 (reviewed April 8, 2026) requires a TAR for all BHT. The TAR must include the "Medical or mental health diagnosis," the "Length and severity of the condition," a history and physical "including mental status, development status and/or any form of comprehensive diagnostic testing," and "The Functional Behavioral assessment conducted by a Board Certified Behavior Analyst." A signed release of information must accompany "any BHT related clinical documentation or TAR"; it is "valid for one calendar year from the date of signature," and "Failure to do so may result in a delay of service." If the documentation is missing "OR the information is beyond twelve months, Partnership may make a one-time allowance to approve a single visit in order to fulfill TAR requirements." The BHT fax cover has three boxes — Assessment TAR (with a CDE and the ROI), Initial BHT services TAR (treatment plan), Reauthorization TAR (treatment plan with goal progress).[2][3][5]
Submission: "Electronic submission will allow for more expedient processing. If online submission is not possible, the TAR may be submitted via fax (707) 863 - 4118." Retro TARs must arrive "within fifteen (15) business days of the date of service," or within 60 calendar days of a primary insurer’s denial.[2][3][5]
Partnership states it "is the primary Provider of medically necessary BHT services" and must fill gaps the school district leaves; it "must not assume that BHT services included in a Member’s IEP/IHSP/IFSP are actively being provided by the LEA." A child moving from a Regional Center automatically generates a continuity-of-care request, and continuity with an out-of-network BHT provider can run up to 12 months when the member saw that provider in the prior six months — paid at no less than "the established Medi-Cal Fee for Service (FFS) rate for the applicable BHT service." Members turning 21 get a transition plan toward community agencies or the Regional Center.[2]
Partnership’s claims policy CLPM-05 (reviewed 9/1/2026): “Partnership Healthplan of California (Partnership) has a one-year billing limit. Providers have 365 days from the date of service to submit claims to Partnership for payment consideration. Claims received on the 366th day from the date of service will be denied.” The exception is other primary coverage: bill Medicare or the other plan within one year of the month of service, and if its EOB arrives after the 365 days have run, you have 60 days from the EOB date to bill Partnership. Over-one-year exceptions (retroactive eligibility, court orders, hearings) carry delay reason code 10. Under CLPM-15, 95% of clean claims are paid or denied within 45 working days, 90% of clean claims from individual or group practitioners are paid within 30 days of receipt and 99% within 90 days, and late payments on complete claims carry interest at 15% per annum. Since January 1, 2026 state law also requires Medi-Cal managed care plans to pay a complete claim within 30 calendar days of receipt, with 15% annual interest from day 31 (AB 3275: H&S § 1371 applied to Medi-Cal plans by W&I § 14093.08); CLPM-15 has not yet been rewritten to say so.[15][16][1][17]
Disputes (CLPM-41): providers "have 365 calendar days to dispute a claim from the original date on the Partnership RA"; Partnership acknowledges within 2 working days for electronic submissions (15 for paper) and sends a Claims Dispute Response Letter within 45 working days.[15][16][1][17]
The questions that decide whether a family can start with Partnership HealthPlan of California (Medi-Cal), and what they have to bring. Each maps onto something intake should ask on the first call.
"Be under 21 years of age" (MCUP3126); members approaching 21 get a transition plan toward providers, community agencies or the Regional Center.[2]
A soft 12-month rule: "If the above documentation is not available OR the information is beyond twelve months, Partnership may make a one-time allowance to approve a single visit in order to fulfill TAR requirements."[2]
The recommendation must come from "a licensed physician, surgeon or psychologist" stating BHT is medically necessary "regardless of diagnosis"; the functional behavior assessment must be "conducted by a Board Certified Behavior Analyst." LCSW: no — the recommendation must come from a licensed physician, surgeon or psychologist.[2]
None named — the TAR needs "any form of comprehensive diagnostic testing." UM uses the policy’s own criteria, "current clinical criteria and guidelines," and (generally) InterQual.[2][3]
No PCP referral form is required for BHT: the TAR is "to be submitted by the provider performing these services," and the fax cover also accepts a "Referral for BHT services for review." What is required is the physician/surgeon/psychologist recommendation and the signed ROI.[4][5][2]
MCUP3041: non-urgent pre-service decisions "within seven (7) calendar days from the receipt of the request, but no later than 14 calendar days"; urgent pre-service "within 72 hours"; a TAR lacking clinical information "may be deferred/pended up to 14 calendar days." Retro TARs within 15 business days of service. Reauthorization: the treatment plan is reviewed "no less than once every six months," and the ROI must be renewed yearly.[3][2]
"The primary carrier must be billed first … A copy of the EOB or RA from the primary carrier should be attached … Partnership /Medi-Cal is always the payer of the last resort." Partnership accepts retro TARs "within 60 calendar days of a denial from the primary insurance carrier" — which means it still expects its own authorization when it ends up paying behind another plan.[7][3]
Partnership’s telehealth policy lets covered CPT/HCPCS services, "subject to any existing treatment authorization requirements," be delivered by telehealth when clinically appropriate, with documented consent, POS 02/10 and modifier 95 (video) or 93 (audio-only); MCUP3126 contemplates BHT "on-site at school or during remote school sessions." No BHT-specific restriction (e.g. on technician-delivered 97153) is published.[6][2]
Ask the plan: Partnership Health Services (BHT TAR review) — ask on the TAR whether remote 97153 is approved for this member.
Coverage decides whether Partnership HealthPlan of California (Medi-Cal) 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.
"Partnership only credentials Licensed Medical Professionals or BACB® certified providers … Providers who are not licensed or BACB® certified may only provide ABA services while under the supervision of a Partnership credentialed provider," and "BCaBA providers must work under the supervision of a Partnership credentialed BCBA." No numeric supervision ratio is published.[9]
No caps: "Blanket limitations or restrictions on benefits and services, such as caps on number of hours, are prohibited" (MCUP3126).[2]
MCUP3126: the provider "Delivers BHT services in a home or community-based setting, including clinics," with any school-based hours "proportionate to the Member’s medical need," including on-site at school or during remote school sessions.[2]
BHT must be delivered by a QAS Provider, Professional or Paraprofessional meeting the State Plan; Partnership credentials BCBA, BCBA-D and BCaBA (re-credentialing every 36 months), and "Individual unlicensed ABA therapists must submit to a criminal background check by Partnership" (group-employed unlicensed staff need a background check too). Contracted rates sit in each provider’s Partnership contract; non-contracted providers are paid "the State of California Medi-Cal fee-for-service rates."[2][9][8]
Not addressed in MCUP3126 or MCUP3041. Partnership’s claims manual says it "follows State of California Medi-Cal Provider Manual unless otherwise stated" — and the state BHT manual is itself silent on 97153 with 97155 in the same clock time.[18][19]
Ask the plan: Partnership Claims Department or provider relations — ask whether 97153 and 97155 may be billed for the same minutes.
Not addressed in the BHT policy.[2]
Blocked on: Partnership’s medical-record standards policy (not read this cycle) on partnershiphp.org / PowerDMS.
Yes — as Behavioral Health Treatment for Medi-Cal members under 21 in its 24 northern counties, reviewed by Partnership itself (not Carelon) through Treatment Authorization Requests.
A signed release of information (valid one year), a physician/surgeon/psychologist recommendation, a diagnosis, the H&P and diagnostic testing, and a BCBA’s functional behavior assessment — records older than 12 months only earn a one-time single visit.
Within 7 calendar days of receipt (up to 14 if information is missing), and within 72 hours for urgent requests.
State rule: APL 23-010 requires every Medi-Cal plan to offer continued access to out-of-network BHT providers (continuity of care) for up to 12 months under APL 23-022, so ask Partnership HealthPlan for a continuity-of-care arrangement before treatment stops. No state document says whether an existing authorization follows the child to a new agency within the plan; ask the plan before switching.
365 days from the date of service (a 12-month billing limit, policy CLPM-05). Disputes are due within 365 calendar days of the date on the Partnership remittance advice and are answered within 45 working 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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