---
title: UnitedHealthcare ABA coverage in Hawaii (commercial).
url: "https://carelu.com/payers/unitedhealthcare-hawaii"
markdown_url: "https://carelu.com/payers/unitedhealthcare-hawaii.md"
state: HI (Hawaii)
payer: UnitedHealthcare / Optum in Hawaii
kind: Commercial insurance
description: "How UnitedHealthcare commercial plans handle ABA in Hawaii — Optum’s ABA clinical criteria, prior authorization, diagnostic-tool and supervision rules, Luke’s Law (under 14, $25,000/yr ABA cap), and why self-funded plans may sit outside it."
last_reviewed: October 2026
---

# UnitedHealthcare ABA coverage in Hawaii (commercial).

_Payer Guide · UnitedHealthcare · Hawaii · Last updated October 2026 · 15 primary sources_

> UnitedHealthcare commercial in Hawaii — Optum behavioral health, Optum ABA criteria, and Luke’s Law (under 14, $25K/yr ABA).

UnitedHealthcare’s commercial ABA coverage in Hawaii runs on Optum: behavioral health is administered by Optum, and medical necessity is judged against Optum’s ABA clinical criteria (reviewed August 2025, interim review April 2026). We found no Hawaii-specific UnitedHealthcare commercial ABA policy; Optum’s Hawaii ABA page covers the QUEST (Medicaid) program, not commercial plans. The Hawaii layer is Luke’s Law for fully insured plans. Self-funded employer plans are governed by their plan documents, so check funding first.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment** _(plan-dependent)_: Plan-dependent — Optum’s ABA criteria state "Prior authorization is required for ABA (unless otherwise specified or mandated by contract or law)"; whether the assessment codes are included varies by plan [3]
  - Ask the plan: Optum via providerexpress.com or the behavioral health number on the member card — ask about 97151/97152.
- **Prior auth for treatment**: Required — "Prior authorization is required for ABA (unless otherwise specified or mandated by contract or law)" (Optum ABA clinical criteria). Reviews: “At a minimum, most treatment reviews are required every 4-6 months depending on the account/state law” (Optum ABA CPT FAQ) [11][3]
- **Autism diagnosis required?**: Yes — ASD (or another diagnosis required by governing law) issued by a state-licensed physician, psychologist or other qualified licensed clinician under DSM-5-TR, confirmed with at least one clinically validated tool [3]

## At a glance

- **Covers ABA?:** Yes — for ASD, per Optum’s ABA clinical criteria (behavioral health via Optum)
- **State mandate:** Luke’s Law — HRS § 431:10A-133 (insurers), a parallel HRS ch. 432 art. 1 section (mutual benefit societies such as HMSA), HRS § 432D-23 (HMOs such as Kaiser); Act 235, 2015
- **Mandate age:** Individuals under fourteen years of age
- **Mandate caps:** ABA capped at $25,000 per year for children ages thirteen and under; cost-sharing no less favorable than for substantially all medical services
- **Exempt from mandate:** Self-funded employer (ERISA) plans; disability, accident-only, Medicare, Medicare supplement, student accident and health, dental-only and vision-only policies, and policies or renewals of six months or less
- **Licensure:** Yes — HRS ch. 465D licensed behavior analyst (DCCA): passed BCBA exam + active BCBA/BCBA-D; RBTs and BCaBAs exempt when working under a licensed behavior analyst
- **Fee schedule:** None published — paid at the contracted rate on your Optum fee schedule

## Optum’s criteria, Hawaii’s mandate

Optum’s ABA criteria require a valid ASD diagnosis "issued by a state licensed physician, psychologist, or other state licensed clinician qualified to make such diagnosis" under DSM-5-TR, with diagnosis and severity confirmed by at least one clinically validated tool (screening tools such as M-CHAT, second-level tools such as CARS-2, or formal tools such as ADI-R and ADOS-2). Treatment is delivered by a BCBA or credentialed licensed clinician, with technicians — preferably RBTs — under supervision. Direct case supervision is "1–2 hours for every 10 hours of direct treatment per week." Daily notes must record place of service, start and stop times, who delivered and who attended, interventions and credentials. Optum says it does not recommend parents serving as RBTs for their own child. [3]

The first question is funding: a self-funded employer plan administered by UnitedHealthcare follows its plan document, and Luke’s Law does not reach it. For fully insured plans, the mandate below applies. [3]

## The Hawaii mandate: Luke’s Law

Hawaii’s autism mandate is Luke’s Law, Act 235 of 2015. It added the same autism section three times — to the insurance code as HRS § 431:10A-133, to chapter 432 for mutual benefit societies (HMSA’s chapter), and, through HRS § 432D-23, to HMO contracts — so every state-regulated carrier in Hawaii carries it. The text is narrow by current standards. Policies issued or renewed after January 1, 2016 must cover the diagnosis and treatment of autism for "individuals under fourteen years of age," and applied behavior analysis "shall be subject to a maximum benefit of $25,000 per year for services for children ages thirteen and under." Payments for anything other than ABA do not count toward that cap, and cost-sharing may be "no less favorable" than for substantially all medical services. [4][5]

The statute also sets rules intake should know: treatment requests "shall include a treatment plan," and the carrier may review the plan and medical necessity at its discretion; treatment must be "prescribed or ordered" by a licensed physician, psychiatrist, psychologist, licensed clinical social worker or registered nurse practitioner; coverage excludes custodial care, services by family or household members, experimental treatment and "services provided outside of the State"; network autism providers must clear state and federal criminal background checks; and a child diagnosed under an older DSM edition "may be required to undergo repeat evaluation" when a new edition is published. Exempt: self-funded employer plans (not state-regulated insurance) and disability, accident-only, Medicare, Medicare supplement, student, dental-only and vision-only policies and policies of six months or less. Whether a $25,000 annual ABA dollar limit can still be applied to a given plan alongside federal parity rules is a plan-level question; the statute text itself has not been amended since 2015. [4][5]

## Licensure in Hawaii

Hawaii licenses behavior analysts under HRS chapter 465D, run by the Department of Commerce and Consumer Affairs. A license requires having passed the BCBA examination and maintaining active BACB status as a BCBA or BCBA-D (HRS § 465D-8). Section 465D-7 exempts, among others, BCaBAs practicing "under the direction of a licensed behavior analyst," RBTs who directly implement ABA "under the direction of a licensed behavior analyst or a licensed psychologist," licensed psychologists and their supervisees, and graduate students and people accruing BACB experience hours under a licensed behavior analyst. Luke’s Law then limits covered autism treatment to providers "licensed by a state licensure board," so the supervising analyst on a commercial claim needs the Hawaii license, not just BACB certification. [7][6][16][4]

## How does UnitedHealthcare (Optum) pay for ABA, and how do you join the network?

UnitedHealthcare commercial ABA is managed by Optum Behavioral Health, which publishes no ABA rate table. Optum's ABA FAQ tells contracted providers to "bill your contracted billing codes and customary charges as outlined on your Fee Schedule after receiving appropriate authorization. You will be reimbursed based on your contracted rate." The fee schedule is the one attached to your Optum agreement; non-contracted providers get approvals through the behavioral-health number on the member's card. [11]

Joining the network: Optum lists credentialing and contracting criteria for ABA providers (BCBA with active certification, state licensure where the state licenses behavior analysts, six months of supervised ABA experience, and professional liability of $1 million per occurrence) and takes applications through the "Join Our Autism/ABA Network" section of its ABA page on Provider Express. Credentialing "can take from 45 to 120 days after submission of all materials," every new agency gets a site audit that can take up to 90 days to schedule, and a single case agreement while credentialing is "Not automatically" available, only in exception cases such as a network gap. Technicians working 1:1 must hold RBT, BCAT or ABAT certification (or an approved alternative). [11]

## How fast must UnitedHealthcare pay a clean ABA claim in Hawaii?

Hawaii’s prompt-pay statute covers insurers issuing comprehensive medical plans, as well as mutual benefit societies and HMOs. "Unless shorter payment timeframes are otherwise specified in a contract," a claim that is not contested or denied must be paid within thirty calendar days of receiving a written claim or fifteen calendar days of receiving an electronic one. A contested or denied claim must be flagged within 15 days (written) or 7 days (electronic), naming the contested part and the reason, unless the plan sends at least a monthly reimbursement report carrying that information. After you supply requested information the same 30- or 15-day clock applies, and late payments carry interest "at a rate of fifteen per cent a year," added automatically once it reaches $2. Before recouping a payment the plan must give 30 days’ written notice, and you have 60 days from that notice to appeal (HRS § 431:13-108). Self-funded employer plans are not covered by the statute. [17]

## What is the timely filing limit for UnitedHealthcare ABA claims?

UnitedHealthcare commercial ABA runs through Optum Behavioral Health, whose National Provider Network Manual (effective 9/1/2026) says "All information necessary to process claims must be received by Optum 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." Corrections are due within 90 days of the first claim’s receipt, the member cannot be billed for a late claim, and reconsideration plus appeal must be filed within 12 months in total unless state law or your agreement says otherwise. [12][2][1]

Optum’s National Network Manual (effective September 1, 2026) also sets the payment clock: claims with all required information and any required authorization "will be paid within 45 calendar days after Optum receives the claim, or as required by state and federal laws," which may exclude claims needing a coordination-of-benefits determination, and when Optum is secondary it pays up to the Optum contracted rate. UnitedHealthcare’s 2026 administrative guide adds that a corrected claim (frequency code 7, with the original claim number) must arrive within the same timely-filing limit as the original. No weekly payment cycle or submission cutoff is published. [12][2][1]

Which codes: Optum’s commercial ABA reimbursement policy (2022RP501A, updated June 2026) lists the reimbursable codes for the commercial ABA program as 97151–97158, 0362T and 0373T, each in 15-minute units; 97151–97158 carry a credential modifier (HM, HN, HO or HP), while 0362T and 0373T are listed as "Additional Autism/Applied Behavior Analysis Codes that do not require modifiers"; no HCPCS H-code (H0031, H0032, H2014, H2019) is on that list. [12][2][1]

## 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. [1][2]

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. [1][2]

## What must a UnitedHealthcare ABA reauthorization request contain, and are graphs required?

Optum’s ABA Supplemental Clinical Criteria (interim review April 2026) say that "With each clinical review for continued ABA treatment, the provider must submit updated documentation" showing progress "for each targeted symptom and behavior, including progress toward defined goals, including the same modes of measurement that were utilized for baseline measurement." Progress "should include 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," with movement from baseline shown on validated, norm-referenced assessments and, where applicable, the caregiver’s own progress. Inadequate progress over six months calls for an analysis of the reasons and modified interventions, and the review looks at use below 80 percent of authorized hours over two weeks. The criteria do not require graphs as such. [3]

## Network, single case agreements, authorizations and disputes (Optum)

Single case agreements: Optum's ABA FAQ says an SCA during credentialing is granted "Not automatically. In exception cases, based on clinical need, new business implementations, or other gaps in the network, a SCA may be approved after review with the clinical team." Once an SCA provider becomes contracted, it sends its current member list to its Network Manager to have the authorizations updated. Out-of-network providers bill on the standard Form 1500. [11][1][12]

Joining the network: Optum lists its ABA contracting criteria (a BCBA with state licensure where the state licenses behavior analysts, six months of supervised ABA experience, $1 million/$1 million professional liability for an individual; $1 million/$3 million plus general or supplemental liability for a group). Credentialing "can take from 45 to 120 days after submission of all materials," and every new ABA agency needs an Optum site audit that "can take up to 90 days to schedule." None of these Optum documents says the ABA network is closed to new providers. [11][1][12]

Whose authorization it is: when an agency is credentialed, "their affiliated clinicians are not credentialed but are considered participating under the agency's Participation Agreement," but "Any claims submission for a rendering clinician who has not been added to the network is subject to denial." Approvals are issued in code clusters (assessment 97151/97152; direct care 97153/97154; multi-staff 0362T/0373T; QHP services 97155–97158) and units "can shift" within a cluster. Optum publishes no rule on moving an authorization from one agency to another; "All services require prior approval," so a new agency calls the ABA team for its own approval. [11][1][12]

Credential modifiers (commercial ABA program): HM = RBT (less than a bachelor's), HN = BCaBA (bachelor's), HO = master's-level BCBA or licensed mental health provider, HP = BCBA-D or doctoral-level licensee; one provider-level modifier per line. 0362T and 0373T are listed as codes "that do not require modifiers." [11][1][12]

Disputes: network providers follow a 2-step process — Step 1 reconsideration, Step 2 appeal — with "a total of 12 months for submission for both steps" unless state law or the Participation Agreement sets another deadline. Send "member-specific treatment plans, clinical records, payment appendices or other items that support why you believe our decision was incorrect," plus proof the claim was filed on time; mail to Optum Behavioral Health Solutions, P.O. Box 30757, Salt Lake City, UT 84123, or use Provider Express. Non-urgent clinical appeals have a 180-day window. [11][1][12]

## Intake gates

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

- **Diagnosis recency**: No expiry stated; continued coverage needs current progress data and documentation through each authorization period. Luke’s Law lets a carrier ask for a repeat evaluation when a new DSM edition is published. [3][4]
- **Who may diagnose**: A "state licensed physician, psychologist, or other state licensed clinician qualified to make such diagnosis." LCSW: yes — Optum accepts an "other state licensed clinician qualified to make such diagnosis," and Hawaii puts "Clinical diagnosis" inside the LCSW scope (HRS § 467E-1(8)). Hawaii scope rule: the practice of social work includes "(8) Clinical diagnosis or psychotherapy, or both, provided by a licensed clinical social worker" (HRS § 467E-1), and Luke's Law covers autism treatment "prescribed or ordered" by a licensed physician, psychiatrist, psychologist, licensed clinical social worker or registered nurse practitioner (HRS § 431:10A-133). [3][15][4]
- **Diagnostic tools required**: At least one clinically validated tool confirming diagnosis and severity — screening (ABC, M-CHAT, CSBS-DP-IT, ASQ, AQ, CAST), second-level (CARS-2, RITA-T, STAT) or formal diagnostic (ADI-R, ADOS-2, DISCO). [3]
- **Referral required?**: Optum requires prior authorization, not a referral. Luke’s Law covers treatment "prescribed or ordered" by a licensed physician, psychiatrist, psychologist, LCSW or registered nurse practitioner, with a treatment plan on each request. [3][4]
- **Telehealth**: Three codes, after an attestation. Optum’s Telehealth Billing guide (updated September 2025) is explicit for commercial plans: “For ABA services, telehealth is only allowed for these 3 CPT codes: 97155, 97156 or 97157” — virtual supervision of technicians and family training — so technician-delivered 97153 is not payable by telehealth. The provider must first be “an approved Optum virtual visits provider who has attested” (the virtual-visits attestation on Provider Express) and must tell the ABA Care Advocate at authorization. Bill the in-person code with the member’s location as the place of service: POS 10 when the member is at home, POS 02 anywhere else (the older ABA CPT FAQ says POS 02; the 2025 guide requires one of the two on every behavioral-health telehealth claim, and POS 11 or a telehealth modifier alone is not paid). Optum’s criteria add that telehealth is “not intended to supplant in-person service.” The assessment is not on that list: 97151 (initial assessment and reassessment) and 97152 are not payable by telehealth for commercial members, so plan the assessment in person. Supervision is: 97155 is billed with the in-person code and POS 02 or 10 after the attestation (Optum's ABA FAQ, Q29), and Optum publishes no minimum in-person share of supervision. [13][11][3]
- **Age limit** _(plan-dependent)_: Optum’s criteria set no age cap. Luke’s Law requires coverage only for children under 14 on fully insured plans; beyond 13 it depends on the plan, and self-funded plans are outside the statute. [3][4]
  - Ask the plan: Optum benefits verification — funding type and the plan’s ABA age terms.
- **Prior-auth decision time** _(plan-dependent)_: Group plans follow 29 CFR 2560.503-1 (directly or through 45 CFR 147.136): pre-service decisions "not later than 15 days," one 15-day extension, urgent within 72 hours. We found no shorter Hawaii initial-decision statute; HRS § 432E-5 sets internal appeals at 72 hours expedited and 60 days. [8][9][10]
  - Ask the plan: Optum at authorization — confirm turnaround and continuation lead time for the plan.
- **Other insurance (who pays first)** _(plan-dependent)_: Order is set by the plans’ COB provisions; ask which plan is primary. If the child also has QUEST, UnitedHealthcare pays first and Medicaid last. TRICARE pays after this plan; CHAMPVA pays last. [18][19][20][21]
  - Ask the plan: Optum benefits verification — record every other coverage.

## Delivery and billing rules

Coverage decides whether UnitedHealthcare / Optum in Hawaii 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 of care, direct case supervision is required 1–2 hours for every 10 hours of direct treatment per week." Technicians must be under a BCBA or licensed behavioral health clinician; in Hawaii, RBTs and BCaBAs practice only under a licensed behavior analyst’s direction (HRS § 465D-7). [3][6]
- **Concurrent billing (97153 + 97155)**: Yes, with a single-provider exclusion. Optum’s commercial ABA reimbursement policy: “Can I report 97153 or 97154 with 97155 concurrently? A. Yes, as long as the criteria in the descriptors of both codes are met. A single QHP may not report 97153 or 97154 with 97155 concurrently.” So the overlap has to be two people — a technician on 97153 and an analyst on 97155 directing them with the patient present. Optum’s ABA CPT FAQ adds that 97153 and 97156 “may be billed concurrently” as separate services to different family members by different providers. 97155 and 97156 on the same date pay only if “separate, distinct, and clearly documented in the progress notes” — “A single provider can’t bill for both simultaneously.” Team meetings bill only as supervision with the member, supervisor and technician present, and “CPT codes 97153 and 97155 may not be billed for technician training.” [12][11]
- **Daily limits / MUEs**: Optum’s commercial ABA reimbursement policy (2022RP501A, updated June 2026) sets a maximum frequency per day for every 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), 0373T 32 (8 hrs) — and “If a provider bills in excess of 32 units per day, claims may be subject to non-reimbursement or recovery.” The ABA CPT FAQ confirms “For our commercial ABA program MUE’s apply.” There is no weekly hour cap: hours are authorized on documented clinical need, approved units can be shifted among codes within a cluster, and utilization below 80% of authorized hours over a two-week period is addressed at review. On fully insured Hawaii plans Luke’s Law caps ABA at $25,000 a year for children 13 and under. [12][11][3][4]
- **Session-note signature**: “Provider signature is required on progress notes. Parent/guardian signatures are not required on progress notes” (Optum ABA CPT FAQ). Each daily session note records place of service, start and stop time, who rendered the service, the specific service, who attended and the interventions. Optum’s ABA documentation protocol (June 1, 2026) requires the “signature of the rendering provider” and “Legible identity of the rendering provider with credentials,” and “The date of signature must reflect the date the note is finalized” — a note signed after the date of service must follow late-entry rules and show the date it was signed. Same-date services must be “separate, distinct, and clearly documented in the progress notes,” or the claim may be denied. [11][14][12]
- **Place of service**: Optum’s criteria allow clinic, home, school and telehealth delivery (citing CASP telehealth guidance) at the least restrictive appropriate level, with IEP coordination. Luke’s Law excludes "services provided outside of the State." [3][4]
- **Bill as provider**: Care is delivered by a BCBA or a credentialed licensed clinician, with BCaBAs and technicians under their supervision. In Hawaii the supervising analyst needs an HRS ch. 465D license, and Luke’s Law covers treatment only from a state-licensed provider. Plan-specific billing-provider rules are in the reimbursement policy. [3][7][4]

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

- **Fully insured or self-funded:** Decides whether Luke’s Law applies at all.
- **Group number and employer name:** Needed to establish funding type and verify ABA benefits through Optum.
- **Diagnosis with a validated tool:** Optum wants the DSM-5 diagnosis and severity confirmed with at least one clinically validated tool.
- **Child’s age:** Luke’s Law covers children under 14, with ABA capped at $25,000 a year for ages 13 and under.

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

## Common questions

### Does UnitedHealthcare / Optum give single case agreements for ABA?

Not automatically. Optum's ABA FAQ says an SCA may be approved "In exception cases, based on clinical need, new business implementations, or other gaps in the network" after review with the clinical team. Credentialing takes 45 to 120 days, and new agencies also need a site audit.

### Does UnitedHealthcare require graphs for ABA reassessments?

Optum’s criteria require updated progress data in the same measures used at baseline (mastery rates, change scores, updated standardized adaptive measures) at every continued review; they do not require graphs as such.

### Does UnitedHealthcare accept H0031 or H0032 for ABA?

Optum’s commercial ABA reimbursement policy lists only CPT 97151–97158, 0362T and 0373T as reimbursable ABA codes, each with a credential modifier; no H-code (H0031, H0032, H2014, H2019) is on the list.

### Does UnitedHealthcare cover ABA in Hawaii?

Yes, under Optum’s ABA clinical criteria, with behavioral health administered by Optum. Fully insured plans also carry Luke’s Law: coverage for children under 14, ABA capped at $25,000 a year for ages 13 and under.

### Does Luke’s Law apply to every UnitedHealthcare plan?

No. Self-funded employer plans follow their plan documents, not state insurance mandates, so check funding type first.

### How often does UnitedHealthcare (Optum) reauthorize ABA?

Optum, which manages UnitedHealthcare’s behavioral health benefits, says “At a minimum, most treatment reviews are required every 4-6 months depending on the account/state law.” Call in the continued-care request “no more than 30 days prior to the current approvals on file expiring,” with updated progress data measured the same way as baseline and updated standardized measures. There is no fixed reassessment frequency (“There is no required frequency at which an assessment must take place”) — ask for reassessment hours inside the treatment request. If more hours are needed mid-authorization, call the ABA team with a clinical rationale.

### Can the ABA assessment (97151) or BCBA supervision (97155) be done by telehealth with UnitedHealthcare in Hawaii?

Supervision yes, assessment no. For commercial plans Optum allows telehealth only on 97155, 97156 and 97157, after a virtual-visits attestation, billed with POS 02 or 10. The 97151 assessment is not on that list.

### What is UnitedHealthcare's ABA fee schedule in Hawaii?

There is no public one. Optum pays contracted providers at the rate on the fee schedule in their Optum agreement.

### Is UnitedHealthcare (Optum) accepting new ABA providers in Hawaii?

Optum takes ABA applications through the "Join Our Autism/ABA Network" section of Provider Express. Credentialing takes 45 to 120 days after a complete submission, plus a site audit for new agencies. Optum publishes no statement that its network is closed.

### What is UnitedHealthcare’s timely filing limit for ABA in Hawaii?

90 calendar days from the date of service under Optum’s National Provider Network Manual, unless law or the member’s plan allows longer.

### 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 Behavioral Health National Network Manual (BH02330, published July 1, 2026, effective Sept. 1, 2026): Coordination of Benefits; Timely Filing; Payment Timelines](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/adminResourcesMain/netwmanual/NNManual.pdf)
2. [2026 UnitedHealthcare Care Provider Administrative Guide (Commercial): Timely filing of corrected claims; Subrogation and COB](https://www.uhcprovider.com/content/dam/provider/docs/public/admin-guides/2026-UHC-Administrative-Guide.pdf)
3. [Optum Behavioral Health — Supplemental Clinical Criteria: Applied Behavior Analysis (annual review Aug 2025, interim Apr 2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaSCC.pdf)
4. [HRS § 431:10A-133 — Autism benefits and coverage; notice; definitions (Luke’s Law; current text, archived 8/10/2026)](https://www.capitol.hawaii.gov/hrscurrent/Vol09_Ch0431-0435H/HRS0431/HRS_0431-0010A-0133.htm)
5. [S.B. 791 C.D. 1 (2015), enacted as Act 235 — Luke’s Law: §§ 3–6 add the insurer, mutual-benefit-society and HMO autism sections](https://www.capitol.hawaii.gov/session2015/bills/SB791_CD1_.htm)
6. [HRS § 465D-7 — Behavior analysts: exemptions (am. L 2023, c 167)](https://www.capitol.hawaii.gov/hrscurrent/Vol10_Ch0436-0474/HRS0465D/HRS_0465D-0007.htm)
7. [HRS § 465D-8 — Behavior analysts: application for licensure](https://www.capitol.hawaii.gov/hrscurrent/Vol10_Ch0436-0474/HRS0465D/HRS_0465D-0008.htm)
8. [29 CFR 2560.503-1 — ERISA claims procedure (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
9. [45 CFR 147.136 — Internal claims and appeals for group and individual coverage (eCFR)](https://www.ecfr.gov/current/title-45/subtitle-A/subchapter-B/part-147/section-147.136)
10. [HRS § 432E-5 — Complaints and appeals procedure for enrollees](https://www.capitol.hawaii.gov/hrscurrent/Vol09_Ch0431-0435H/HRS0432E/HRS_0432E-0005.htm)
11. [Optum — FAQ: Autism/ABA Using CPT Codes (BH00083-24-FAQ, 01/2024)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaCPT-FAQs.pdf)
12. [Optum — ABA Reimbursement Policy, Commercial (2022RP501A, updated 06/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/reimbPolicies/abaReimburs2020s.pdf)
13. [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)
14. [Optum — Medical Records Documentation for Reviews of ABA Services (BH02325, 6/1/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/OBHS_ABA_Services_Documentation_Protocols.pdf)
15. [HRS § 467E-1 — Social workers: definitions (practice of social work incl. "(8) Clinical diagnosis or psychotherapy, or both, provided by a licensed clinical social worker")](https://www.capitol.hawaii.gov/hrscurrent/Vol10_Ch0436-0474/HRS0467E/HRS_0467E-0001.htm)
16. [HRS § 465D-2 — Behavior analysts: definitions](https://www.capitol.hawaii.gov/hrscurrent/Vol10_Ch0436-0474/HRS0465D/HRS_0465D-0002.htm)
17. [HRS § 431:13-108 — Reimbursement for accident and health or sickness insurance benefits (Hawaii Revised Statutes)](https://www.capitol.hawaii.gov/hrscurrent/Vol09_Ch0431-0435H/HRS0431/HRS_0431-0013-0108.htm)
18. [Med-QUEST memo QI-2431 / FFS 24-13 (Dec 31, 2024) — Coverage of IBT for children under 21 with ASD: Guidelines for ABA (Attachments A–C)](https://medquest.hawaii.gov/content/dam/formsanddocuments/provider-memos/qi-memos/qi-memos-2024/QI-2431,%20FFS%2024-13%20Replaces%20QI-2301,%20FFS%2023-01%20Coverage%20of%20IBT%20for%20treatment%20of%20children%20under%2021%20years%20of%20age%20with%20ASD_Guidelines%20for%20ABA._FINAL%20(part%201)%20-%20signed.pdf)
19. [42 CFR 433.139 — Medicaid payment of claims involving third-party liability (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-433/subpart-D/section-433.139)
20. [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)
21. [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.