---
title: "UnitedHealthcare / Optum ABA coverage in Alaska: the intake guide."
url: "https://carelu.com/payers/unitedhealthcare-alaska"
markdown_url: "https://carelu.com/payers/unitedhealthcare-alaska.md"
state: AK (Alaska)
payer: UnitedHealthcare / Optum in Alaska
kind: Commercial insurance
description: "How UnitedHealthcare / Optum covers ABA for Alaska families: Optum’s ABA criteria and prior authorization, Alaska’s AS 21.42.397 autism mandate (under 21, no visit limits, small-group exemption), Alaska behavior-analyst licensure, and what intake should verify."
last_reviewed: October 2026
---

# UnitedHealthcare / Optum ABA coverage in Alaska: the intake guide.

_Payer Guide · UnitedHealthcare · Alaska · Last updated October 2026 · 20 primary sources_

> Optum criteria (BH803ABASCC) + Alaska’s AS 21.42.397 mandate; no Alaska state supplement; three-code telehealth list.

For an intake team in Alaska, a UnitedHealthcare card means three layers: Optum Behavioral Health’s national ABA criteria, Alaska’s autism mandate in AS 21.42.397, and the plan’s funding type and employer size, which decide whether the mandate applies. Alaska Medicaid has no managed care plans, so a UHC card here is commercial (or Medicare). Note that Optum’s former role as Alaska Medicaid’s behavioral health ASO ended December 31, 2024 and has nothing to do with UHC commercial plans.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required: the ABA Supplemental Clinical Criteria require prior authorization for ABA "unless otherwise specified or mandated by contract or law" [1]
- **Prior auth for treatment** _(plan-dependent)_: Required: treatment authorization under the same criteria; the review interval is set per authorization [1]
  - Ask the plan: Optum Provider Express support at (866) 209-9320: ask what review interval will be set on this member’s ABA treatment authorization.
- **Autism diagnosis required?**: Yes: a valid ASD diagnosis by a state-licensed physician, psychologist or other qualified state-licensed clinician, with DSM-5 diagnosis and severity level confirmed and documented by the diagnosing clinician [1]

## At a glance

- **Covers ABA?:** Yes, for ASD, per Optum’s ABA Supplemental Clinical Criteria
- **State mandate:** AS 21.42.397 (coverage for autism spectrum disorders)
- **Mandate age:** Under 21: coverage "is required to be provided only to individuals under 21 years of age"
- **Mandate caps:** No dollar cap and no visit limits in the statute; ordinary cost-sharing applies
- **Exempt from mandate:** Self-funded ERISA plans; small-group employers with 20 or fewer employees; waiver possible for 21–25 employees; fraternal benefit societies
- **Licensure:** Required: Alaska behavior-analyst license (AS 08.15); technicians exempt when directed by a licensed behavior analyst
- **Fee schedule:** Not public — Optum pays up to the “Fee Maximum” in your agreement, by credential level (HM/HN/HO/HP modifiers)

## The national policy, applied in Alaska

UnitedHealthcare administers ABA through Optum Behavioral Health under the ABA Supplemental Clinical Criteria (BH803ABASCC; interim review April 2026): prior authorization for ABA, a DSM-5 diagnosis with severity level confirmed by the diagnosing clinician, and continued-service review that looks hard at use below 80% of authorized hours over a two-week period. Optum’s ABA State Mandates supplement (July 2026) has sections for Arizona, California, Massachusetts, Pennsylvania and Virginia only; Alaska is not there, so no Alaska-specific criteria modify the commercial policy. Optum’s Alaska Medicaid ASO contract ended December 31, 2024, and UnitedHealthcare has no Alaska Medicaid plan (the state has none). [1][2][6][20]

## The Alaska mandate: what it guarantees

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. [7]

## Licensure, out-of-state BCBAs and rates

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. [8][17][9][10][19]

## Claims: filing, payment and what UnitedHealthcare pays

UnitedHealthcare publishes no ABA rate table; Optum pays from the contract. Its National Network Manual (effective Sept. 1, 2026) defines the "Fee Maximum" as the maximum amount a participating provider may be paid for a service, adding that "Reimbursement to clinicians is based upon licensure rather than degree." Optum’s commercial ABA Reimbursement Policy (updated 06/2026) puts the credential on every line: HM for an RBT, HN for a BCaBA, HO for a master’s-level BCBA or licensed clinician, HP for a doctoral-level provider, and notes that state regulatory requirements "may supplement, modify or supersede" it. 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. For a public benchmark, Alaska Medicaid pays 97153 at $31.95 per 15 minutes from July 1, 2026. [5][4][11][12][19]

Optum’s National Network Manual: claims must be received "no more than 90 calendar days from the date of service, or as allowed by state or federal law or the member’s specific benefit plan," and "Any corrections or additions to a claim should be made within 90 days of initial claim receipt." Complete, authorized claims "will be paid within 45 calendar days after Optum receives the claim, or as required by state and federal laws," which may exclude claims that need coordination-of-benefits decisions; the manual sets no separate secondary-claim deadline and publishes no check-run schedule. [5][4][11][12][19]

## Does UnitedHealthcare need a referring provider on the ABA claim?

Not for ABA. Optum, which manages UnitedHealthcare’s behavioral benefit, says in its National Network Manual (effective September 1, 2026) that a claim must carry the coding (ICD diagnosis, CPT/HCPCS and modifiers), the member ID number, customary charges, and the provider’s TIN and NPI. Paper Form 1500 claims add the member and subscriber names and dates of birth, the length of session, the type and duration of service, and the clinician’s name, credentials, Tax ID and NPI. A referring provider is not on either list. [5][21]

UnitedHealthcare’s 2026 administrative guide requires the referring provider’s name and NPI only on laboratory, DME, imaging and home health claims. For every other claim, it requires “a valid billing NPI, rendering NPI and relevant taxonomy code(s)” and says “we encourage you to submit the referring health care provider’s NPI.” In short, the referring NPI is optional on an ABA claim, and leaving it off is not a denial reason under either document. [5][21]

## What a reauthorization must show

Optum’s ABA Supplemental Clinical Criteria (review 04/2026) set what each continued-service review needs: progress "assessed and documented for each targeted symptom and behavior … including the same modes of measurement that were utilized for baseline measurement"; progress that includes "rate and percentage of mastered programs, rates of mastered targets, change scores for any outcome measures, updated standardized adaptive measures, and change scores for skills-based assessments"; an assessment of the reasons and modified interventions when there is inadequate progress "within a 6-month period"; and an explanation when use of authorized hours falls below 80% over a two-week period. Treatment plans "are usually reviewed/updated twice annually." The criteria do not require graphs. [1]

## Intake gates

The questions that decide whether a family can start with UnitedHealthcare / Optum in Alaska, and what they have to bring.

- **Diagnosis recency**: No expiry on the diagnosis; the DSM-5 diagnosis and severity level must be confirmed and documented by the diagnosing clinician. Use below 80% of authorized hours over two weeks triggers review. [1]
- **Who may diagnose**: A "state licensed physician, psychologist, or other state licensed clinician qualified to make such diagnosis." [1]
- **Diagnostic tools required**: At least one clinically validated tool from a non-exhaustive list of first-level screens (M-CHAT and others), second-level screening tools, and formal diagnostic tools (ADI-R, ADOS-2 and others). [1]
- **Referral required?**: No separate physician referral; the SCC require prior authorization. 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][7]
- **Telehealth**: Three codes. Optum’s Telehealth Billing guide (September 2025) says for commercial plans: "For ABA services, telehealth is only allowed for these 3 CPT codes: 97155, 97156 or 97157." So the 97151 assessment and technician 97153 are not on Optum’s list. Bill POS 10 (home) or 02 (elsewhere); Optum will not pay a telehealth claim carrying only a modifier. The SCC add that telehealth options "are not intended to supplant in-person service." 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). Ask Optum how it applies the three-code list to a fully insured Alaska plan. [3][1][10][8][9]
- **Age limit** _(plan-dependent)_: The SCC carry no age criterion; the member’s benefit plan governs. 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][7]
  - Ask the plan: Provider Express benefits check or the behavioral health number on the card: establish fully insured vs. self-funded ERISA and employer size first.
- **Prior-auth decision time** _(plan-dependent)_: 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. UnitedHealthcare/Optum publishes no Alaska-specific ABA turnaround or reauthorization lead time. [13][14][18]
  - 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 UnitedHealthcare/Optum expects.
- **Other insurance (who pays first)** _(plan-dependent)_: Alaska requires every major medical policy to carry a coordination-of-benefits provision (AS 21.42.205), and when a child has two plans the secondary insurer, "absent evidence of fraud, … must accept the primary insurer’s precertification, utilization review, or other managed care requirement determination and may not deny, delay, or reduce benefits" for a member who met the primary’s requirements (3 AAC 26.110(c)). Neither text sets the order of benefits between two parents’ plans, so get the order from the carrier. If the child also has Alaska Medicaid, UnitedHealthcare/Optum pays first: Medicaid is payer of last resort (42 CFR 433.139), and an Alaska Medicaid provider must report any other payment and enter it "as a credit against the charge to the department" (7 AAC 145.005(i)). TRICARE pays after this plan (10 U.S.C. 1079(i)(1)); CHAMPVA is the last payer (38 CFR 17.270). [15][16][22][23][24][25]
  - Ask the plan: Ask UnitedHealthcare/Optum at benefits verification for the member’s coordination-of-benefits order (and whether the plan uses the birthday rule for two parents’ plans), and record every other coverage the child has.

## Delivery and billing rules

Coverage decides whether UnitedHealthcare / Optum in Alaska 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**: Consistent with CASP standards, direct case supervision runs at 1–2 hours for every 10 hours of direct treatment per week. Technicians work under a BCBA or licensed behavioral health clinician and "should be registered behavior technicians (RBT) or another appropriately certified behavior technician as allowable by state mandate"; Optum does not recommend parents serving as their own child’s RBT. In Alaska the supervising behavior analyst must hold an Alaska license (AS 08.15.010). [1][8]
- **Daily limits / MUEs**: Optum’s commercial ABA reimbursement policy (2022RP501A, which applies to Commercial and Individual Exchange plans) sets a maximum frequency per day for each code: 97151 32 units (8 hrs), 97152 16 (4 hrs), 97153 32 (8 hrs), 97154 18 (4.5 hrs), 97155 24 (6 hrs), 97156 16 (4 hrs), 97157 16 (4 hrs), 97158 16 (4 hrs), 0362T 16 (4 hrs) and 0373T 32 (8 hrs). CMS MUEs otherwise apply, and billing more than 32 units of 97153 in a day "may be subject to non-reimbursement or recovery." There are no weekly unit caps. Weekly hours come from the authorization. No numeric cap. Requested hours must be justified by documented clinical need; at continued-service review, use below 80% of authorized hours over a two-week period must be explained. For fully insured Alaska plans, AS 21.42.397(b)(2) bars limiting "the number of visits to an autism service provider." [4][1][7]
- **Place of service**: Not covered: services that are not ABA, "such as 1:1 aid delivered simultaneously during classroom instruction," or services covered under IDEA; school coordination is allowed. AS 21.42.397(b)(4) requires fully insured plans to cover medically necessary treatment coordinated with an education program, without making coverage contingent on it. [1][7]
- **Bill as provider**: The credentialed ABA provider is a BCBA or licensed behavioral health clinician; a BCaBA or non-licensed staff member works under that provider’s direct supervision. Each line carries the rendering credential modifier (HM RBT, HN BCaBA, HO master’s-level, HP doctoral). [1][4]
- **Concurrent billing (97153 + 97155)** _(ask the plan)_: Not addressed. The SCC define direct case supervision as happening during direct treatment but do not state the billing consequence. [1]
  - Ask the plan: Optum National Network Manual and the participating-provider agreement, or a written coding determination from Optum.
- **Session-note signature** _(ask the plan)_: Not addressed. The SCC set what must be documented for coverage, not who signs a session note or when. [1]
  - Ask the plan: Optum National Network Manual (documentation standards) and the participating-provider agreement.

## What intake should collect for UnitedHealthcare / Optum in Alaska

- **Plan funding type and employer size:** Fully insured (AS 21.42.397 applies) vs. self-funded ERISA, and whether the employer is a small group of 20 or fewer (exempt).
- **Child’s age:** The Alaska mandate requires coverage only under 21.
- **Diagnosis with a validated tool:** DSM-5 ASD and severity level, confirmed by the diagnosing clinician with a validated tool (ADI-R, ADOS-2 and others).
- **Prescription and treatment plan:** AS 21.42.397 ties coverage to treatment prescribed by a physician, psychologist or APRN, in a plan following a comprehensive evaluation.

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

## Common questions

### Does UnitedHealthcare (Optum) require graphs for ABA continued-service reviews?

No. Optum’s criteria ask for progress on every target using the baseline measurement method, mastery rates and change scores, updated standardized adaptive measures, and an explanation of low hour use, but they do not require graphs.

### What are UnitedHealthcare (Optum)’s claim filing deadlines for Alaska ABA claims?

90 calendar days from the date of service (or longer where state law or the plan allows), corrections within 90 days of the original claim’s receipt, and payment of complete claims within 45 days or the state’s shorter clock. No check-run schedule is published.

### Does UnitedHealthcare cover ABA therapy in Alaska?

Yes, under Optum’s national ABA criteria for ASD, with Alaska’s AS 21.42.397 mandate layered on for fully insured plans. Self-funded employer plans and small groups of 20 or fewer employees are outside the mandate.

### Does Optum have Alaska-specific ABA criteria?

No. Optum’s ABA State Mandates supplement (July 2026) covers Arizona, California, Massachusetts, Pennsylvania and Virginia, not Alaska.

### Is Optum still Alaska Medicaid’s behavioral health administrator?

No. Optum’s ASO contract with Alaska’s Division of Behavioral Health ended December 31, 2024; Alaska Medicaid claims now go to the state MMIS through HMS Gainwell.

### Can ABA be delivered by telehealth with UnitedHealthcare in Alaska?

Optum’s commercial telehealth guide allows only 97155, 97156 and 97157 by telehealth, billed POS 10 or 02. Fully insured Alaska plans must also cover telehealth by Alaska-licensed providers under AS 21.42.422, so ask Optum how it applies the list to your plan.

### Does UnitedHealthcare require a referring provider (box 17) on ABA claims?

No. Optum’s claim requirements do not include a referring provider. UnitedHealthcare makes the referring name and NPI mandatory only for lab, DME, imaging and home health claims. For other claims it encourages the referring NPI but does not require it.

## Primary sources

1. [Optum ABA Supplemental Clinical Criteria (BH803ABASCC; annual review 8/2025, interim review 4/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaSCC.pdf)
2. [Optum — ABA State Mandates supplemental criteria (BH 803ABA, July 2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/scc/ABA_SCC_SM.pdf)
3. [Optum — Telehealth Billing Quick Reference Guide (BH01511, updated September 2025)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/home/Telehealth_Billing_Guide_Updates.pdf)
4. [Optum — ABA Reimbursement Policy, Commercial (2022RP501A, updated 06/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/reimbPolicies/abaReimburs2020s.pdf)
5. [Optum National Network Manual (BH02330, effective Sept. 1, 2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/adminResourcesMain/netwmanual/NNManual.pdf)
6. [Optum — Transition of Alaska Medicaid Contract (BH00573-24-ALT, Sept. 5, 2024: ASO contract ends Dec. 31, 2024)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/ourNetworkMain/welcomeNtwk/alaska/AlaskaMedicaidTransition2024.pdf)
7. [AS 21.42.397 — Coverage for autism spectrum disorders](https://www.akleg.gov/basis/statutes.asp?media=print&secStart=21.42.397&secEnd=21.42.397)
8. [AS 08.15 — Behavior Analysts (license required; temporary license; exemptions)](https://www.akleg.gov/basis/statutes.asp?media=print&secStart=08.15.010&secEnd=08.15.990)
9. [AS 08.02.130 — Telehealth (licensed providers; out-of-state physician exception)](https://www.akleg.gov/basis/statutes.asp?media=print&secStart=08.02.130&secEnd=08.02.130)
10. [AS 21.42.422 — Coverage for telehealth (commercial)](https://www.akleg.gov/basis/statutes.asp?media=print&secStart=21.42.420&secEnd=21.42.425)
11. [AS 21.36.495 — Prompt payment of health care insurance claims](https://www.akleg.gov/basis/statutes.asp?media=print&secStart=21.36.495&secEnd=21.36.495)
12. [AS 21.07 — Patient and provider protection; required contract provisions (AS 21.07.020: no retroactive denial of preauthorization)](https://www.akleg.gov/basis/statutes.asp?media=print&secStart=21.07.001&secEnd=21.07.250)
13. [3 AAC 28.900–28.989 — Utilization review, grievances and external review (3 AAC 28.910 standard, 28.912 expedited, 28.936 180-day grievance)](https://www.akleg.gov/basis/aac.asp?media=print&secStart=3.28.900&secEnd=3.28.999)
14. [SB 133 (2025), enrolled — prior authorization deadlines, AS 21.07.100–21.07.180 (plans issued or renewed on or after Jan. 1, 2027)](https://www.akleg.gov/PDF/34/Bills/SB0133Z.PDF)
15. [AS 21.42.205 — Coordination of benefits provision required](https://www.akleg.gov/basis/statutes.asp?media=print&secStart=21.42.205&secEnd=21.42.205)
16. [3 AAC 26.110(c) — Secondary insurer must accept the primary insurer’s precertification](https://www.akleg.gov/basis/aac.asp?media=print&secStart=3.26.010&secEnd=3.26.999)
17. [BACB — U.S. Licensure of Behavior Analysts (Alaska, 2014: Division of Corporations, Business and Professional Licensing)](https://www.bacb.com/u-s-licensure-of-behavior-analysts/)
18. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
19. [Alaska DOH, Division of Behavioral Health — Medicaid Procedure Codes and Rates, Autism Services (effective July 1, 2026)](https://health.alaska.gov/media/3kyjzoiw/fy2027-autism-services-fee-schedule-2026-07-01.pdf)
20. [Alaska House Finance Committee minutes, Feb. 13, 2025 (Department of Health: Alaska Medicaid is fee-for-service)](https://www.akleg.gov/pdf/34/M/HFIN2025-02-130902.pdf)
21. [2026 UnitedHealthcare Care Provider Administrative Guide (Commercial), Chapter 10: complete claim and NPI requirements](https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/2026-UHC-Administrative-Guide.pdf)
22. [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)
23. [7 AAC 145.005 — Conditions for payment (12-month claim deadline; payment from other sources)](https://www.akleg.gov/basis/aac.asp?media=print&secStart=7.145.001&secEnd=7.145.060)
24. [10 U.S.C. 1079(i)(1) — TRICARE pays after other coverage except Medicaid](https://www.govinfo.gov/content/pkg/USCODE-2023-title10/html/USCODE-2023-title10-subtitleA-partII-chap55-sec1079.htm)
25. [38 CFR 17.270 — CHAMPVA is the last payer](https://www.ecfr.gov/current/title-38/section-17.270)

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.