Wellpoint Iowa is the IA Health Link plan formerly branded Amerigroup Iowa, and both names still circulate on member cards, in older documents and in clearinghouse directories. Its September 2026 provider manual lists behavioral health intervention services "including applied behavior analysis" as covered for Medicaid and Iowa Health and Wellness Plan members ("may require prior authorization") and as not covered for Hawki. Behind the plan sits Carelon Behavioral Health, "an independent company providing behavioral health management services on behalf of Wellpoint, Inc.," which handles behavioral health credentialing and provider service. What Wellpoint does not publish in a document we could open is its ABA medical-necessity criteria: the manual says mental-health requests are reviewed against "Wellpoint Medical Policies and Clinical Utilization Management Guidelines," but the Iowa guideline list names no ABA guideline.
Wellpoint "accepts prior authorization requests via phone, fax or Interactive Care Reviewer (ICR), a secure utilization management tool available in Availity." For Medicaid behavioral health, the plan's prior-authorization page gives an inpatient fax of 1-844-442-8016 and an outpatient fax of 1-844-451-2826; the state's uniform outpatient form 470-5595 lists the same outpatient number. The Precertification Lookup Tool (PLUTO) is the code-level answer. Claims go through Availity under payer ID WLPNT.[2][7][5]
Carelon's Iowa Medicaid quick reference guide routes Wellpoint behavioral health credentialing and provider demographic changes through Carelon's National Provider Service Line (1-800-397-1630) and customer service through 1-833-731-2143. Enrollment and verification run through Wellpoint.[2][7][5]
We could not find a Wellpoint Iowa ABA clinical guideline, unit cap, supervision standard or telehealth position in the provider manual, the Clinical UM Guideline list (Nov. 2025), or the plan's public pages. The manual says criteria are available on request (providernetworkia@wellpoint.com, 833-731-2143). Until that document is in hand, the state rules on the Iowa Medicaid guide are the working floor: the supervising licensed behavior analyst submits technician claims, the state telehealth list governs codes, and the record rule in 441—79.3 governs notes. Do not assume Wellpoint's ABA criteria in another state carry over to Iowa.[1][4]
The questions that decide whether a family can start with Wellpoint Iowa (formerly Amerigroup Iowa), and what they have to bring. Each maps onto something intake should ask on the first call.
Follows the state list; Wellpoint's manual has no ABA telehealth rule of its own. Iowa Medicaid allows 97151–97158 by audio/video with modifier 95, POS 02 or 10, and no audio-only.[10][11]
Routine requests: "the Medical Management department will make a determination as quickly as possible, but always within 7 calendar days of a routine request." Urgent: when more information is needed "the Medical Management team will submit a request within 24 hours," and the provider "will then have 48 hours to provide the additional clinical information." If a request arrives without enough clinical information, Wellpoint makes "at least one attempt" to get it; with no response, "the request will be reviewed with the information originally submitted and denied." The state form 470-5595 caps urgent decisions at 72 hours (42 CFR 438.210). No ABA reauthorization lead time is published.[1][7]
Bill the other plan first. "Providers must submit coordination of benefits (COB) claims to the primary carrier before submitting to Wellpoint," then submit the total billed charges with the primary's remittance advice or a letter explaining the denial; COB claims without one "will be denied with a directive to submit to the other healthcare program first." Wellpoint pays first and recovers later only for preventive pediatric services (including EPSDT) and certain child-support-enforced coverage unpaid after 30 days. Medicaid is payer of last resort under 42 CFR 433.139. The manual does not say whether Wellpoint's own ABA authorization is required when another plan is primary.[1][12]
Not published by Wellpoint. Hawki members are excluded; the Iowa Medicaid benefit's age range could not be confirmed.[1]
Blocked on: Wellpoint Provider Services 833-731-2143, or Iowa Medicaid Informational Letter 1976 (ABA).
Not published by Wellpoint.
Blocked on: The ABA criteria document Wellpoint provides on request (providernetworkia@wellpoint.com, 833-731-2143).
Not published by Wellpoint.
Blocked on: The ABA criteria document Wellpoint provides on request (providernetworkia@wellpoint.com, 833-731-2143).
Not published by Wellpoint.
Blocked on: The ABA criteria document Wellpoint provides on request (providernetworkia@wellpoint.com, 833-731-2143).
Not published by Wellpoint for ABA.
Blocked on: The ABA criteria document Wellpoint provides on request, or Provider Services 833-731-2143.
Coverage decides whether Wellpoint Iowa (formerly Amerigroup Iowa) 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.
Follows the state rule; Wellpoint's September 2026 manual publishes no ABA supervision standard of its own. Every RBT "must provide treatment under the supervision of a behavior analyst or assistant behavior analyst licensed pursuant to Iowa Code chapter 154D," and assistant behavior analysts work under a licensed behavior analyst. No supervision percentage is set at either level.[6][1]
Follows the state record rule; the Wellpoint manual publishes nothing ABA-specific. Each service record must show the beginning and ending time for time-based codes, the name and credentials of the person who provided the service, and "the signature of the person providing the service, or the initials ... if a signature log indicates the person's identity."[8]
Follows the state rule, which Wellpoint does not modify in its manual: RBT and assistant-analyst services are claimed by "the supervising licensed behavior analyst," with the HN, HO or HP modifier that the Iowa fee schedule prices. Claims go through Availity, payer ID WLPNT.[6][9][5]
Not published by Wellpoint or the state.
Ask the plan: Wellpoint Provider Services 833-731-2143: ask whether 97153 and 97155 for overlapping time both pay.
Not published. The approved units are stated in each authorization.
Ask the plan: The Wellpoint authorization letter, or Provider Services 833-731-2143.
Not published by Wellpoint for ABA.
Blocked on: Wellpoint Provider Services 833-731-2143, or the ABA criteria document Wellpoint provides on request.
Yes for IA Health Link Medicaid and Iowa Health and Wellness Plan members: its September 2026 manual lists behavioral health intervention services "including applied behavior analysis" as covered (may require prior authorization). Not for Hawki members.
Yes. Wellpoint is the current brand for the plan formerly called Amerigroup Iowa, and both names still appear on cards and in payer directories.
By phone, by fax to the Medicaid behavioral health outpatient line 1-844-451-2826, or through Interactive Care Reviewer in Availity. Check PLUTO for which codes need authorization.
Payer policies change frequently and vary by plan, state, and funding type. This guide was compiled from the sources above and last reviewed September 2026; it is general information, not billing, legal, or clinical advice. Always verify current requirements against the payer's live policy and a benefits check for the specific member.
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