---
title: "UnitedHealthcare ABA coverage in Oklahoma: the intake guide."
url: "https://carelu.com/payers/unitedhealthcare-oklahoma"
markdown_url: "https://carelu.com/payers/unitedhealthcare-oklahoma.md"
state: OK (Oklahoma)
payer: UnitedHealthcare in Oklahoma
kind: Commercial insurance
description: "How UnitedHealthcare (Optum Behavioral Health) covers ABA for Oklahoma families: the Optum ABA Supplemental Clinical Criteria, assessment and treatment authorization, supervision and concurrent billing, Nick’s Law (36 O.S. § 6060.21) with no age limit or cap since 2022, Oklahoma licensure, and what intake should verify."
last_reviewed: October 2026
---

# UnitedHealthcare ABA coverage in Oklahoma: the intake guide.

_Payer Guide · UnitedHealthcare · Oklahoma · Last updated October 2026 · 17 primary sources_

> Optum ABA criteria (BH803ABASCC) + Nick’s Law: assessment and treatment both authorized, concurrent 97153/97155 billable.

UnitedHealthcare commercial ABA runs through Optum Behavioral Health and the Provider Express portal, under Optum’s ABA Supplemental Clinical Criteria (interim review April 2026). Optum publishes ABA state pages for about eighteen states and plans; Oklahoma is not one of them, so the national criteria plus Oklahoma’s mandate (Nick’s Law) for fully insured plans are the picture. Self-funded employer plans answer to their plan document, so funding type comes first.

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Required — UHC behavioral health runs through United Behavioral Health, operating under the brand Optum; its CPT FAQ says "All services require prior approval," the SCC say "Prior authorization is required for ABA," and the Provider Express portal takes separate "ABA Assessment or Treatment" authorization requests. [3][2][4]
- **Prior auth for treatment**: Required — "At a minimum, most treatment reviews are required every 4-6 months depending on the account/state law"; supervision hours and future assessments are requested with the treatment request. [3][2]
- **Autism diagnosis required?**: Yes — a DSM-5-TR ASD diagnosis from a state-licensed physician, psychologist or other qualified licensed clinician, confirmed with at least one clinically validated tool; older Asperger’s or PDD-NOS labels need an updated DSM-5 diagnosis. [2][3]

## At a glance

- **Covers ABA?:** Yes — for ASD, per the Optum ABA Supplemental Clinical Criteria
- **State mandate:** Nick’s Law — 36 O.S. § 6060.21 (2016; amended 2019 and by SB 1240, eff. 11/1/2022)
- **Mandate age:** No age limit since 11/1/2022 (earlier versions: under 9, or 6 years if diagnosed after age 3)
- **Mandate caps:** None — no visit limits, and no dollar limits, deductibles or coinsurance worse than medical/surgical; the 25 hr/wk and $25,000/yr ABA cap was repealed in 2022
- **Exempt from mandate:** Self-funded ERISA employer plans; limited-benefit policies; a plan approved for the 1% premium-cost exemption (§ 6060.22)
- **Fee schedule:** Contracted — Optum pays participating ABA providers “based on your contracted rate” for the codes on their fee schedule
- **Licensure:** OK Licensed Behavior Analyst / certified assistant (59 O.S. § 1928) — OKDHS DDS through 10/31/2026, Board of Examiners of Psychologists from 11/1/2026

## The national policy, applied in Oklahoma

Optum requires a DSM-5-TR ASD diagnosis from "a state licensed physician, psychologist, or other state licensed clinician qualified to make such diagnosis," confirmed with at least one clinically validated tool (screeners such as the M-CHAT or CARS-2 up to formal instruments such as the ADI-R and ADOS-2). Prior authorization applies to all ABA, with assessment and treatment requested separately in the Provider Express portal and treatment reviews generally every four to six months. The SCC tie supervision to "one to two hours for every ten hours of direct treatment," expect progress within six-month windows, and flag use of under 80% of authorized hours over two weeks at review. Optum’s CPT FAQ settles the billing questions other carriers leave open: supervision and technician time may be billed concurrently (97153 with 97155), 97153 and 97156 may run concurrently, provider signatures are required on progress notes, and modifiers identify the credential (HM technician, HN BCaBA, HO BCBA, HP BCBA-D). [2][3][4]

## The Oklahoma mandate: what Nick’s Law guarantees now

36 O.S. § 6060.21 requires "a health benefit plan and the Oklahoma Employees Health Insurance Plan" to cover "the screening, diagnosis and treatment of autism spectrum disorder in individuals." Since SB 1240 took effect on November 1, 2022, the statute has no age window and no ABA cap: coverage "shall not be subject to any limits on the number of visits," and dollar limits, deductibles and coinsurance may be no less favorable than for substantially all medical and surgical benefits. The earlier versions (2016 and 2019) limited coverage to children under nine (or six years of coverage if diagnosed after age three), capped ABA at 25 hours a week and $25,000 a year, and excluded ACA individual and small-group plans; all three limits are gone from the current text. The "health benefit plan" definition reaches group and individual medical insurance, HMOs and PPOs; self-funded employer plans are governed by ERISA instead, and limited-benefit policies (specified disease, dental or vision only, short-term plans of six months or less) fall outside the definition. [5][6][7][8]

Four more terms shape intake. ABA coverage "shall include the services provided or supervised by a board-certified behavior analyst, a board-certified assistant behavior analyst or a licensed doctoral-level psychologist." Treatment must be "prescribed or ordered for an individual diagnosed with an autism spectrum disorder by a licensed physician or a licensed doctoral-level psychologist." Outside inpatient care the insurer may review the treatment plan annually, more often only by agreement for that one patient, at the insurer’s cost. And under § 6060.22 a plan whose premium costs rise more than 1% from providing ABA can ask the Insurance Commissioner for an exemption, backed by an actuary’s signed request. [5][6][7][8]

## Licensure & rates in Oklahoma

Oklahoma requires a state license to practise ABA. Under 59 O.S. § 1928, "No person shall practice applied behavior analysis without obtaining a license or certification," supervisees practise only under a licensed behavior analyst, and licensed human services professionals (psychologists, LPCs, LCSWs, OTs, SLPs and others) may practise ABA within their scope. Through October 31, 2026 the Licensed Behavior Analyst credential (BCBA) and the certified assistant behavior analyst (BCaBA) are issued by OKDHS Developmental Disabilities Services; SB 1557 moves both to the State Board of Examiners of Psychologists from November 1, 2026 and adds a national criminal history check. UnitedHealthcare does not publish commercial ABA rates for Oklahoma; they are set in the Optum network agreement. Oklahoma Medicaid gives a public benchmark: the July 1, 2026 SoonerCare fee schedule pays $17.35 per 15-minute unit of 97153 and $23.55 for 97151, 97155 and 97156. [9][10][13]

## Joining the Optum ABA network, and how it pays

UnitedHealthcare’s commercial ABA runs through Optum Behavioral Health, whose ABA FAQ sets the contracting criteria. An individual behavior analyst needs active BACB certification, state licensure or certification where the state licenses or certifies behavior analysts, compliance with state autism mandate requirements, at least six months of supervised ABA experience or training, and $1 million per occurrence / $1 million aggregate professional liability. An ABA group adds program oversight by a behavior analyst or licensed clinician, direct supervision of behavior technicians in joint sessions, training and supervision of BCaBAs and technicians, who must “hold applicable state licensure or certification,” and $1 million / $3 million professional liability plus general or supplemental liability. Applications go through the “Join Our Autism/ABA Network” section of Provider Express. Contracted providers bill “your contracted billing codes and customary charges as outlined on your Fee Schedule after receiving appropriate authorization” and are “reimbursed based on your contracted rate”; a provider not yet contracted calls the Behavioral Health number on the member’s ID card for approvals. Telehealth is limited to 97155, 97156 and 97157, so the 97151 assessment is delivered in person. [3]

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

On fully insured coverage, Oklahoma’s prompt-pay statute requires every insurer, HMOs included, to "reimburse all clean claims of an insured, an assignee of the insured, or a health care provider within forty-five (45) calendar days after receipt of a paper claim and thirty (30) calendar days after receipt of an electronic claim." A claim with defects must be flagged in writing within 30 calendar days, naming the part that is holding it up and what is needed; once the information arrives, the insurer pays or denies within the same 45 or 30 days. A denial must be explained in writing within 30 days, with where to send an appeal, and an overdue payment "shall bear simple interest at the rate of ten percent (10%) per year" (36 O.S. § 1219). The statute reaches entities the Insurance Commissioner regulates, so a self-funded employer plan administered by UnitedHealthcare is outside it and follows its plan document. [18]

## 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, and the member cannot be billed for a late claim. Clean claims are "Generally" paid within 45 calendar days. To dispute a decision, request reconsideration and then appeal; the two steps together must be filed within 12 months unless state law or your agreement sets a different deadline. [14][1][19]

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. [14][1][19]

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 with a credential modifier (HM, HN, HO or HP); no HCPCS H-code (H0031, H0032, H2014, H2019) is on that list. [14][1][19]

## 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. [2]

## Intake gates

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

- **Diagnosis recency**: No fixed expiry. Optum says "Members need to have an updated DSM-5 diagnosis of Autism Spectrum Disorder," and "There is no required frequency at which an assessment must take place," with treatment reviews every 4–6 months; the SCC require reassessment of the plan where progress is inadequate within a 6-month period. [3][2]
- **Who may diagnose**: A state-licensed physician, psychologist, or other state-licensed clinician qualified to diagnose under DSM-5-TR. For insured Oklahoma plans Nick’s Law covers treatment prescribed or ordered by a licensed physician or licensed doctoral-level psychologist. [2][5]
- **Diagnostic tools required**: At least one clinically validated tool, from a non-exhaustive list: first-level screeners (ABC, CHAT/M-CHAT, CSBS-DP-IT, ASQ, AQ, CAST), second-level aids (CARS/CARS-2, RITA-T, STAT) and formal diagnostic tools (ADI-R, ADOS/ADOS-2, DISCO). Functional assessments such as the VB-MAPP, ABLLS and Vineland are examples for treatment planning. [2][3]
- **Referral required?**: No referral or order is required by Optum; the gate is prior authorization of the assessment and then treatment. For insured Oklahoma plans the mandate covers treatment prescribed or ordered by a licensed physician or licensed doctoral-level psychologist. Optum publishes no ABA order form or validity period. On the claim, Optum’s National Network Manual (effective Sept. 1, 2026) lists the Form 1500 fields it needs (member and subscriber, diagnosis, dates and length of session, and the clinician who actually provided the service with credentials, Tax ID and NPI) and does not ask for a referring provider in box 17. [2][3][5][19]
- **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.” [15][3][2]
- **Prior-auth decision time**: Optum publishes no ABA decision clock; requests go through the Provider Express portal and reviews recur every 4–6 months. The legal ceiling depends on funding. Fully insured Oklahoma plans fall under the Ensuring Transparency in Prior Authorization Act (eff. 1/1/2025): a decision "within seventy-two (72) hours of obtaining all necessary information" for urgent services and "within seven (7) days of obtaining all necessary information" for non-urgent ones, and services "are deemed authorized" if the deadline is missed and the provider used the plan’s authorized PA system; the approval must state its duration or expiry date, and a new plan must honor a prior authorization from the previous plan "for at least the initial sixty (60) days." Self-funded (ERISA) plans follow 29 CFR 2560.503-1: pre-service decisions "not later than 15 days after receipt of the claim" (one 15-day extension) and urgent care within 72 hours. [3][4][11][20][21][22]
- **Age limit** _(plan-dependent)_: The Optum SCC carry no age criterion; the member’s benefit plan and any state law govern. For insured Oklahoma plans Nick’s Law has had no age window since November 1, 2022. [2][5]
  - Ask the plan: Provider Express eligibility check or the behavioral health number on the member ID card: confirm funding type and any plan age term.
- **Other insurance (who pays first)** _(plan-dependent)_: Optum’s ABA documents do not state an order of benefits. Oklahoma’s coordination-of-benefits rule for insured plans applies the birthday rule to a child on both parents’ plans: the plan of the parent "whose date of birth, excluding year of birth, occurs earlier in a calendar year" pays first; for separated or divorced parents the custodial parent’s plan goes first, then a stepparent’s, then the non-custodial parent’s, and a court decree assigning financial responsibility overrides that order (OAC 365:10-11-3). Self-funded plans follow their plan document. If the child also has SoonerCare, this plan pays first — SoonerCare is payer of last resort, and OHCA expects the family to follow this plan’s rules, including its prior authorization. TRICARE pays after this plan ("TRICARE shall be last pay," 32 CFR 199.8), and "CHAMPVA is the last payer to OHI" (38 CFR 17.276(d)). [12][23][24][25]
  - Ask the plan: UnitedHealthcare customer service at benefits verification: ask for the recorded COB order and, for a self-funded plan, the plan’s own COB rule.

## Delivery and billing rules

Coverage decides whether UnitedHealthcare in Oklahoma 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**: Direct case supervision at one to two hours for every ten hours of direct treatment a week (SCC, consistent with CASP); Optum’s FAQ says "In general, we see 2 hours for every 10 hours" and asks for a clinical rationale above that. Technicians must be RBTs or other certified technicians as state rules allow, under a BCBA or licensed clinician; parents should not serve as RBT for their own child. [2][3]
- **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.” Optum’s ABA documents do not address ABA at the same time as speech, occupational or physical therapy; its ABA FAQ expects the ABA provider to know "the other therapies in which the child is involved, how often those therapies occur" and their goals, and to document that coordination. [14][3]
- **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. For insured Oklahoma plans Nick’s Law forbids visit limits and dollar limits worse than medical/surgical. [14][3][2][5]
- **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. [3][16][14]
- **Place of service**: Home (12), clinic (11), community (99), school (03) and telehealth (10 or 02) are the usual POS codes. Not covered: "1:1 aid delivered simultaneously during classroom instruction" or IDEA-covered services, though school coordination, teacher training, meetings and observation are covered. [3][2]
- **Bill as provider**: A credentialed BCBA or attested licensed clinician is the ABA provider; BCaBAs and technicians work under their direct supervision. Modifiers identify who delivered the service: HM technician, HN BCaBA, HO BCBA, HP BCBA-D. Any supervisor credentialed under the group or facility contract may see the member. [2][3]

## What intake should collect for UnitedHealthcare in Oklahoma

- **Plan funding type:** Fully insured (Nick’s Law applies) vs. self-funded ERISA (plan document governs).
- **Diagnosis with a validated tool:** DSM-5-TR ASD diagnosis and severity level, confirmed by the diagnosing clinician with at least one validated tool. Update any Asperger’s or PDD-NOS label.
- **Provider Express access:** Assessment and treatment are requested separately through the Provider Express portal (One Healthcare ID).
- **Family availability:** Optum reviews utilization under 80% of authorized hours over two weeks. Set hours the family can actually keep.
- **School and IEP status:** Optum will not pay a 1:1 classroom aide or IDEA-covered services, but covers school coordination, teacher training and observation.

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

## Common questions

### 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 therapy in Oklahoma?

Yes, for ASD under Optum’s ABA Supplemental Clinical Criteria, with prior authorization for assessment and treatment. Insured Oklahoma plans also carry Nick’s Law; self-funded plans follow their plan document.

### Can I bill 97153 and 97155 at the same time with UnitedHealthcare?

Yes. Optum’s CPT FAQ allows concurrent billing of technician (97153) and supervisor (97155) time when supervision is provided.

### How often does Optum review ABA treatment?

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.

### What is UnitedHealthcare’s ABA fee schedule in Oklahoma?

Rates are contracted. Optum pays participating providers “based on your contracted rate” for the codes on their fee schedule; non-contracted providers call the Behavioral Health number on the member’s card.

### Can the ABA assessment be done by telehealth with UnitedHealthcare?

Not on commercial plans. Optum allows telehealth only for 97155, 97156 and 97157 after a virtual-visits attestation, so 97151 is in person.

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

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

## Primary sources

1. [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)
2. [Optum ABA Supplemental Clinical Criteria BH803ABASCC (interim review 4/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaSCC.pdf)
3. [Optum FAQ — Autism/ABA using CPT codes (BH00083-24)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/autismABA/abaCPT-FAQs.pdf)
4. [Optum Provider Express — Applied Behavior Analysis providers page (state list has no Oklahoma page)](https://public.providerexpress.com/content/ope-provexpr/us/en/clinical-resources/autismABA2.html)
5. [36 O.S. § 6060.21 — Health coverage for individuals with autism (Nick’s Law; as amended by SB 1240, eff. 11/1/2022) — OSCN](https://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=478381)
6. [36 O.S. § 6060.21 — superseded 2019 version (under-9 age window, 25 hr/wk and $25,000/yr ABA cap) — OSCN](https://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=491671)
7. [36 O.S. § 6060.22 — Exempt health benefit plans (1% premium-cost exemption) — OSCN](https://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=478387)
8. [36 O.S. § 6060.4(C) — "Health benefit plan" definition — OSCN](https://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=87362)
9. [59 O.S. § 1928 — Behavior analyst licensure (version in force through 10/31/2026: OKDHS Developmental Disabilities Services) — OSCN](https://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=553182)
10. [59 O.S. § 1928 — as amended by SB 1557 (Laws 2026, c. 392), eff. 11/1/2026: State Board of Examiners of Psychologists — OSCN](https://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=456318)
11. [36 O.S. § 6570.6 — Prior authorization time frames (eff. 1/1/2025) — OSCN](https://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=538475)
12. [Okla. Admin. Code § 365:10-11-3 — Coordination of benefits, order of benefit determination (Cornell LII)](https://www.law.cornell.edu/regulations/oklahoma/OAC-365-10-11-3)
13. [OHCA — SoonerCare Title XIX fee schedule, effective 07/01/2026 (V3)](https://oklahoma.gov/content/dam/ok/en/okhca/docs/providers/claim-tools/fee-schedules/2026/Prov_fee_sch_TXIX_07012026_V3.txt)
14. [Optum — ABA Reimbursement Policy, Commercial (2022RP501A, updated 06/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/clinResourcesMain/guidelines/reimbPolicies/abaReimburs2020s.pdf)
15. [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)
16. [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)
17. [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)
18. [36 O.S. § 1219 — Time for processing claims; interest on late payment; notice of denial — OSCN](https://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=86431)
19. [Optum Behavioral Health — National Provider Network Manual (published 7/1/2026, effective 9/1/2026)](https://public.providerexpress.com/content/dam/ope-provexpr/us/pdfs/adminResourcesMain/netwmanual/NNManual.pdf)
20. [36 O.S. § 6570.1 — Ensuring Transparency in Prior Authorization Act, definitions (eff. 1/1/2025) — OSCN](https://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=538426)
21. [36 O.S. § 6570.10 — Honoring a prior authorization for the first 60 days of new coverage — OSCN](https://www.oscn.net/applications/oscn/DeliverDocument.asp?CiteID=538484)
22. [29 CFR 2560.503-1(f)(2) — ERISA group health plan claim decision timeframes (eCFR)](https://www.ecfr.gov/current/title-29/section-2560.503-1)
23. [OAC 317:30-3-24 — Third party liability Revised 09-01-25](https://oklahoma.gov/ohca/policies-and-rules/xpolicy/medical-providers-fee-for-service/general-provider-policies/general-scope-and-administration/third-party-liability.html)
24. [32 CFR 199.8 — TRICARE double coverage (eCFR)](https://www.ecfr.gov/current/title-32/subtitle-A/chapter-VII/subchapter-M/part-199/section-199.8)
25. [38 CFR 17.276(d) — CHAMPVA last payer to other health insurance (eCFR)](https://www.ecfr.gov/current/title-38/section-17.276)

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.