Premera Blue Cross Blue Shield of Alaska is the state’s Blue plan. For an intake team that means three layers: Premera’s ABA medical policy 3.01.510, Alaska’s autism mandate in AS 21.42.397, and the plan type on the card (individual, fully insured group, self-funded or shared-administration group, or the Federal Employee Program), which decides both the prior-authorization route and whether the mandate applies.
Premera medical policy 3.01.510 (effective May 1, 2026) covers ABA when the diagnosis, service, setting and provider criteria are met. It recognizes the CPT ABA codes plus several HCPCS codes (H0031, H0032, H2014, H2019, S5108–S5111) used by some plans. Settings are "most often in the home setting or clinic setting" and may be community; services "may be provided in-person or via secure real-time video and audio telehealth/virtual modalities, or via a combination." Some direct treatment may take place at school when autism-related difficulties show up there, but it "must consist entirely of bona-fide ABA treatment activities," and acting as a classroom aide or 1:1 teacher is not covered; "Some plans may exclude coverage of ABA in school or educational settings."[1][2][3][4][5][8]
Prior authorization depends on plan type. Premera Alaska’s October 2026 code list for individual plans marks 97151, 97153, 97154, 97155, 97156, 97158, 0362T and 0373T "Prior Authorization Required" (97152 and 97157 do not appear). The non-individual (group) list puts "Applied behavioral analysis (ABA)" among services requiring prior authorization and sends providers to the Code Check tool in Availity. Requests go through Availity for individual and non-individual members alike, and "Prior authorizations can’t be submitted by phone." Federal Employee Program members use a separate FEP-Alaska ABA prior-approval form, faxed to 866-948-8823, and FEP excludes ABA "performed as part of an educational program; or provided in or by a school/educational setting."[1][2][3][4][5][8]
Alaska’s autism mandate is AS 21.42.397. Every health care insurer that offers, issues, delivers or renews a health care insurance plan in the state (fraternal benefit societies excepted) "shall provide coverage for the costs of the diagnosis and treatment of autism spectrum disorders." The statute names ABA expressly: "habilitative or rehabilitative care" includes "applied behavior analysis or other structured behavioral therapies." Three conditions shape a claim. Treatment must be "prescribed by a licensed physician, psychologist, or advanced practice registered nurse, provided by or supervised by an autism service provider, and as identified in a treatment plan developed following a comprehensive evaluation." An "autism service provider" is someone "licensed, certified, or registered by the applicable state licensing board or by a nationally recognized certifying organization." And coverage "is required to be provided only to individuals under 21 years of age." The statute caps nothing by dollars and says coverage "may not limit the number of visits to an autism service provider for treatment," though ordinary copayments, deductibles, coinsurance and general exclusions apply. It also says coverage "must cover medically necessary treatment that is coordinated with an education program, but may not be contingent on" that coordination. Two employer-size carve-outs matter: an insurer covering a small employer with 20 or fewer employees "is not required to provide" the mandated coverage, and for a small employer with 21 to 25 employees the director may waive it if actual claims experience shows the mandate raised premiums by three percent or more over 12 months. The mandate reaches fully insured plans; self-funded employer plans answer to ERISA and federal parity instead.[9]
Alaska licenses behavior analysts. AS 08.15.010 says "A person may not practice behavior analysis in this state without a license," and practicing without one is a misdemeanor. The licensing agency is the Department of Commerce, Community, and Economic Development (the BACB’s table lists the Division of Corporations, Business and Professional Licensing, licensure since 2014); there is no separate board. A behavior analyst license requires passing the BCBA examination, current BACB certification and a fingerprint-based criminal history check; an assistant behavior analyst license requires BCaBA certification plus proof of direct supervision by a licensed behavior analyst. Technicians are not licensed: the chapter does not apply to "an individual who directly implements applied behavior analysis services, or family member implementing a behavior analysis plan within the home, who acts under the direction of a licensed behavior analyst or licensed assistant behavior analyst." For out-of-state clinicians, the only short route in statute is a temporary license "for 30 days or less in a calendar year" for someone licensed in a state whose requirements are "substantially equivalent." Telehealth does not remove the license requirement: AS 08.02.130 lets "a health care provider licensed in this state," a category that names behavior analysts licensed under AS 08.15, treat a patient in Alaska by telehealth without a prior in-person visit, and its out-of-state exception covers only physicians and members of an out-of-state physician’s multidisciplinary team for life-threatening conditions. The commercial telehealth statute, AS 21.42.422, likewise requires coverage of telehealth "by a health care provider licensed in this state." Commercial ABA rates are negotiated and unpublished; the public benchmark is the Alaska Medicaid autism-services rate chart, which from July 1, 2026 pays 97153 at $31.95 and 97151/97155/97156 at $41.97 per 15 minutes.[10][19][11][12][21][1][7]
Premera’s own policy is consistent: behavior analysts "must be state licensed, or state certified in states that require state licensure," and BCBAs without a state license are accepted only "in states that do not require state licensure." Alaska requires it. Premera says most providers complete credentialing "within 60 days or less," and a practitioner joining a group "is required to complete credentialing prior to seeing enrollees."[10][19][11][12][21][1][7]
Premera asks for claims within 60 days of service "but no later than 365 calendar days from the date of service," and for most plans denies claims received more than 12 months after the date of service "with no member responsibility." A Level I provider appeal "must be submitted within the same 365-days following the action that prompted the dispute," a Level II within 30 calendar days of the Level I decision, and Premera says it is processing appeals within 30 days. On payment, AS 21.36.495 requires a health care insurer to pay or deny a clean claim "within 30 calendar days after the insurer or a third-party administrator under contract with the insurer receives a clean claim," to send any denial or request for information within the same 30 days, and then to pay within 15 calendar days of receiving the requested information; a late claim is presumed clean and accrues 15 percent annual interest. AS 21.07.020 bars an insurer from retroactively denying a preauthorization based on medical necessity unless it rested on "materially incomplete or inaccurate information provided by or on behalf of the provider." Self-funded ERISA plans sit outside both statutes.[6][4][13][14]
For a child whose card is from another Blue plan, Premera’s BlueCard resources page sends eligibility, benefits, claims and payment through Availity: "sign in to Availity and select Other Blue Plans Premera BlueExchange (FEP, Shared Admin) as a payer," with the member’s plan prefix, ID number, first and last name and date of birth. Premera’s BlueCard claims customer service team is at 888-261-9562 (6 a.m. to 5 p.m.).[24]
The member’s home plan sets its own medical policies and pre-authorization rules. Premera links a separate tool to "View medical policies, check pre-certification and pre-authorization requirements, and submit pre-service reviews for out-of-area Blue Plan members." Check the home plan’s ABA requirements there before the first session. Premera’s own code lists apply to Premera members only. Out-of-state Blue Medicaid members are different: "Medicaid members have limited out-of-state benefits, generally covering only emergent situations."[24]
The questions that decide whether a family can start with Premera Blue Cross Blue Shield of Alaska, and what they have to bring. Each maps onto something intake should ask on the first call.
A healthcare professional "whose legally permitted scope of licensure includes diagnosis of psychiatric disorders or neurodevelopmental disorders."[1]
Policy 3.01.510 requires no referral; the code lists require prior authorization with "history and physical, documentation of medical necessity and procedure report." For a fully insured Alaska plan, AS 21.42.397(a) requires the covered treatment to be "prescribed by a licensed physician, psychologist, or advanced practice registered nurse" and identified in a treatment plan developed after a comprehensive evaluation, so keep that prescription and the evaluation in the file. Self-funded ERISA plans sit outside the statute.[1][2][9]
Yes. ABA services, and supervision, "may be provided in-person or via secure real-time video and audio telehealth/virtual modalities, or via a combination" (policy 3.01.510). No code list, modifier or POS is published in the policy. For a fully insured Alaska plan, AS 21.42.422 requires coverage "for benefits provided through telehealth by a health care provider licensed in this state" and bars requiring "prior in-person contact" before payment; the statute does not list which services or codes. Self-funded employer plans are outside it. The clinician must hold an Alaska behavior-analyst license (AS 08.15.010; AS 08.02.130).[1][12][10][11]
Premera’s Alaska manual states the order: the member is primary on the plan where they are the subscriber; for a child on married parents’ plans, "the primary plan is the coverage of the parent with his/her birthday earlier in the year" (the birthday rule); for divorced parents a court decree controls, and otherwise the custodial parent’s plan. "Some group contracts are not subject to state regulations may have unique COB rules." Submit to the primary first and send its processing information with the secondary claim. Under 3 AAC 26.110(c) a secondary insurer must accept the primary’s precertification. If the child also has Alaska Medicaid, Premera pays first (42 CFR 433.139).[6][18][22]
Policy 3.01.510 states no age limit; member contracts govern. For fully insured Alaska plans, AS 21.42.397(b)(1) requires the autism coverage "only to individuals under 21 years of age," with no visit limits and no dollar cap; small-group plans of 20 or fewer employees are exempt. Self-funded ERISA plans are outside the statute, so plan funding type decides whether that binds.[1][9]
Ask the plan: Availity eligibility and benefits on the member ID: confirm plan type (individual, fully insured group, self-funded group, FEP) and any age term.
Depends on how the plan is funded. Fully insured Alaska plans follow 3 AAC 28.910: for a prospective (pre-service) request the insurer must decide and notify "not later than five working days after the date the health care insurer receives the request," with one extension of up to five working days for matters beyond its control; the clock starts when the request is filed under the insurer’s procedures, "without regard to whether all of the information necessary to make the determination accompanies the filing." Urgent requests are decided within 24 hours (3 AAC 28.912). A reduction or termination of an already-certified course of treatment is an adverse determination that must be noticed in time for the member to appeal first. SB 133 (2025) tightens this for plans issued or renewed on or after January 1, 2027: 72 hours for a complete standard request (72 hours excluding weekends if faxed), 24 hours for an expedited one, and a request with no timely written decision or request for information "is considered approved." Self-funded employer (ERISA) plans follow 29 CFR 2560.503-1 instead: pre-service decisions "not later than 15 days after receipt of the claim," one 15-day extension, urgent care within 72 hours. Premera publishes no Alaska-specific ABA turnaround or reauthorization lead time.[15][16][20]
Ask the plan: At benefits verification ask whether the plan is fully insured (Alaska-regulated) or self-funded (ERISA), the plan’s issue or renewal date (SB 133’s 72-hour clock starts with plans issued or renewed on or after 1/1/2027), and what reauthorization lead time Premera expects.
Policy 3.01.510 sets no diagnosis recency rule.[1]
Ask the plan: Premera prior authorization in Availity: ask whether a recent diagnostic evaluation is expected with the initial request.
Policy 3.01.510 names no diagnostic instrument. Prior-authorization requests on the code lists call for history and physical and documentation of medical necessity.[1][2]
Ask the plan: Premera prior authorization in Availity: ask which assessment instruments it expects.
Coverage decides whether Premera Blue Cross Blue Shield of Alaska 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.
Direct treatment by technicians, BCaBAs or supervised clinicians "is provided by the ABA program manager or lead behavioral therapist," and "Some supervisory time (no specific time amount is specified) should be utilized for direct observation"; supervision may be in person or by real-time video. Premera points to the CASP guidelines for frequency and sets no ratio. In Alaska the program manager must hold an Alaska behavior-analyst license (AS 08.15.010), and an assistant needs direct supervision by a licensed behavior analyst.[1][10]
Supervision of a technician is a covered service for the program manager only "while the latter is providing covered direct treatment services," and for that time both the supervision and the technician’s direct treatment are covered. Not medically necessary: "More than one clinician providing direct ABA treatment services to the same identified individual at the same time," or ABA and another therapy (speech, OT) in the same session.[1]
Policy 3.01.510 sets no hour or unit cap and refers to the CASP guidelines on intensity. For fully insured Alaska plans, AS 21.42.397(b)(2) bars limiting "the number of visits to an autism service provider."[1][9]
Home or clinic most often, community settings when needed; school only for bona-fide ABA treatment, never as a classroom aide or 1:1 teacher, and "Some plans may exclude coverage of ABA in school or educational settings." Camps and schools for children with autism are not covered. FEP excludes school-setting ABA.[1][8]
Non-treatment services (assessments, plan development, data analysis, supervision) are covered "only for program managers/lead behavioral therapists"; group sessions and team meetings are covered for one clinician only. Technician supervision time is not billable by the technician. Policy 3.01.510 does not say whose NPI goes on a technician’s claim line.[1]
Ask the plan: Premera provider services (800-722-4714) or Availity payer space: ask whether technician lines bill under the supervising behavior analyst’s NPI or the agency’s.
Yes, under medical policy 3.01.510 for autism spectrum disorder, with Alaska’s AS 21.42.397 mandate (under 21, no visit limits) on fully insured plans.
Yes. ABA is on Premera Alaska’s prior-authorization list for group plans, and the individual-plan code list requires it for 97151, 97153–97156, 97158, 0362T and 0373T. Submit in Availity; phone requests are not accepted. FEP uses its own fax form.
No later than 365 calendar days from the date of service; for most plans claims received after 12 months deny with no member responsibility.
Premera’s policy requires state licensure where a state licenses behavior analysts, and Alaska does: practicing in Alaska, including by telehealth to a child in Alaska, needs an Alaska license, apart from a temporary license of up to 30 days a year for someone licensed in a substantially equivalent state.
Yes, through BlueCard. Run eligibility and submit claims in Availity under "Other Blue Plans Premera BlueExchange." Check the home plan’s ABA pre-authorization rules with Premera’s out-of-area medical policy and pre-service review tool, since Premera’s own code list does not apply.
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.
Carelu collects all of this automatically.
Every ID, document, and detail this payer requires — gathered conversationally the moment a family reaches out, with insurance verified before your team touches the file.
Get a Demo