---
title: "WellSense New Hampshire ABA coverage: the intake guide."
url: "https://carelu.com/payers/wellsense-new-hampshire"
markdown_url: "https://carelu.com/payers/wellsense-new-hampshire.md"
state: NH (New Hampshire)
payer: WellSense Health Plan (New Hampshire)
kind: Medicaid managed care plan (MCO)
parent_program: New Hampshire Medicaid (Medicaid Care Management)
description: "How WellSense Health Plan covers ABA for New Hampshire Medicaid members: its New Hampshire ABA prior authorization form, the codes and authorization periods, the 7-day decision clock, credentialing, and what intake should collect."
last_reviewed: September 2026
---

# WellSense New Hampshire ABA coverage: the intake guide.

_Payer Guide · WellSense · New Hampshire · Last updated September 2026 · 9 primary sources_

> NH Medicaid MCO with its own NH ABA form: 3-month initial, 6-month continued, units per period, BCBA signs.

WellSense Health Plan (listed by DHHS as Well Sense Health Plan) is one of New Hampshire’s three Medicaid Care Management plans. It is also the most explicit of the three about ABA: a New Hampshire-specific ABA prior authorization form, a behavioral health authorization matrix that marks ABA "Prior authorization required," and a provider manual that names "applied behavioral analysts" among the practitioners it credentials. The same company also sells NH Clarity marketplace plans; this guide covers the Medicaid product.

This plan administers the **New Hampshire Medicaid (Medicaid Care Management)** ABA benefit: the state rules are the floor, and this page covers what the plan layers on top. Read it together with the [New Hampshire Medicaid guide](https://carelu.com/payers/new-hampshire-medicaid).

## Prior authorization and diagnosis at a glance

- **Prior auth for the assessment**: Yes. The initial evaluation needs its own approval: "Request for initial evaluation," pages 1–3 of the NH ABA form plus the comprehensive diagnostic evaluation [1][2]
- **Prior auth for treatment**: Yes. "Prior authorization required" for NH Medicaid ABA (matrix eff. 7/1/2026); continued services requested for up to 6 months on pages 1–6 of the form, units per period [2][1][3]
- **Autism diagnosis required?**: Yes. The initial request needs a "Comprehensive diagnostic evaluation completed by a neurologist, pediatrician, psychiatrist, psychologist, or other licensed physician experienced in autism" [1]

## At a glance

- **Covers ABA?:** Yes, for NH Medicaid members (EPSDT, under 21)
- **Prior auth:** Required: initial evaluation, then continued services
- **Periods:** Initial up to 3 months; continued up to 6 months; request units per period, not per week
- **Medicaid codes on form:** 97151, 97153, 97154, 97155, 97156
- **Submit via:** HealthTrio provider portal (preferred) or fax 857-264-2670
- **Decision clock:** 7 calendar days standard, 72 hours urgent

## The New Hampshire ABA form

WellSense’s "Applied Behavioral Analysis Prior Authorization Form, New Hampshire" (updated November 14, 2025) runs in two steps. A "Request for initial evaluation" is pages 1–3 plus the "Comprehensive diagnostic evaluation completed by a neurologist, pediatrician, psychiatrist, psychologist, or other licensed physician experienced in autism." A "Request for continued services" is pages 1–6: prior ABA providers, school and community services, parent participation, coordination with the PCP, behavioral health, school and occupational therapy providers, medications, and a goals table (or an attached treatment plan with the same content), signed by the treating BCBA. "For initial request, you may request services for 3-month timeframe. For continued services, you may request services for 6-month timeframe." Units are requested for the whole period: "Please do NOT request units per week." [1][4][2]

The Medicaid code list on the form is 97151, 97153, 97154, 97155 and 97156; 97152, 97157 and 97158 appear only in the NH Clarity and Medicare section. The form asks for the agency NPI and tax ID, the BCBA’s NPI and "BCBA license #" (New Hampshire issues none, so expect to give the BACB certification number and confirm with the plan). Submit through the HealthTrio provider portal, which WellSense says can return real-time decisions, or fax 857-264-2670. [1][4][2]

## Criteria, credentialing and the behavioral health vendor change

WellSense’s July 2026 behavioral health matrix says the plan uses InterQual criteria (the 2026 sets from June 1, 2026), ASAM or internal medical policies, and for ABA refers New Hampshire Medicaid members to its medical policy "for additional requirements." That policy sits on WellSense’s PolicyTech site, which did not load for automated retrieval. Behavioral health claims also moved in-house: for New Hampshire Medicaid, dates of service through November 30, 2025 went to Carelon and dates of service from December 1, 2025 go to WellSense (inpatient excepted), so older Carelon-era billing instructions no longer apply. On credentialing, the provider manual lists "applied behavioral analysts" among the practitioners WellSense credentials when they are "permitted to practice independently under New Hampshire law." [2][3][5]

## Intake gates

The questions that decide whether a family can start with WellSense Health Plan (New Hampshire), and what they have to bring.

- **Age limit**: Under 21 for NH Medicaid ABA: the benefit is EPSDT, which covers members under 21 (He-W 546.02). WellSense’s NH documents set no different ABA age rule. [7][1]
- **Who may diagnose**: A neurologist, pediatrician, psychiatrist, psychologist, or other licensed physician experienced in autism must complete the comprehensive diagnostic evaluation. [1]
- **Referral required?**: No separate physician order is asked for on the form; the gate is the comprehensive diagnostic evaluation from a listed physician or psychologist. At the state level, ABA must be "recommended by a licensed clinician" experienced in ASD (He-W 589.04(aj)). [1][7]
- **Prior-auth decision time**: Medicaid standard pre-service requests: "Written notification to the member and provider within 7 calendar days of the receipt of request." Urgent or expedited pre-service and concurrent requests: 72 hours. The clock runs from receipt, not from a complete file, so send the full packet the first time. [3][8]
- **Other insurance (who pays first)**: When other coverage is primary, providers must "Pursue payment from all other liable parties prior to submitting claims to WellSense," then bill any secondary balance with the other carrier’s payment or denial details for each line. Medicaid claims must reach WellSense within 120 days of the primary payer’s determination (90 days for NH Clarity). [3][9]

## Delivery and billing rules

Coverage decides whether WellSense Health Plan (New Hampshire) 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**: WellSense publishes no New Hampshire ABA supervision ratio; the form only requires naming the BCBA "who will perform/supervise services." The state rule applies: a BCBA with BACB supervisory certification supervises BCaBAs, RBTs and rehabilitation assistants, with no numeric ratio (He-W 589.04(ah)). [1][7]
- **Daily limits / MUEs**: No daily or weekly cap is published. Units are authorized per period: up to 3 months on an initial request and 6 months on continued services, and the form says "Please do NOT request units per week. Instead request units per authorization period." [1]
- **Concurrent billing (97153 + 97155):** Not published / unverified. Verify via: WellSense ABA medical policy on PolicyTech (bostonmedicalcenter.policytech.com, public site 61882) or the Prior Authorization Department, 877-957-1300. [1][3]
- **Bill as provider** _(ask the plan)_: The form captures both the agency NPI and the BCBA’s NPI and names the BCBA "who will perform/supervise services," but WellSense publishes no rule on whose NPI a technician’s claim goes out under. [1]
  - Ask the plan: WellSense Provider Services, 877-957-1300, or your provider agreement.

## What intake should collect for WellSense Health Plan (New Hampshire)

- **Comprehensive diagnostic evaluation:** From a neurologist, pediatrician, psychiatrist, psychologist or other licensed physician experienced in autism. Attach it to the initial request.
- **Prior and current services:** Other ABA providers, school and community services, OT/PT/speech, and medications all go on the continued-services pages.
- **Care-coordination contacts:** PCP, behavioral health provider and school contacts with dates of communication.
- **Other insurance:** WellSense pays after the primary; you have 120 days from the primary’s determination to bill it.

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

## Common questions

### Does WellSense require prior authorization for ABA in New Hampshire?

Yes, both for the initial evaluation and for continued services, on its New Hampshire ABA form or through the HealthTrio portal.

### How long is a WellSense NH ABA authorization?

Up to 3 months for an initial request and 6 months for continued services, with units requested for the whole period rather than per week.

### Who can diagnose for a WellSense ABA request?

A neurologist, pediatrician, psychiatrist, psychologist, or other licensed physician experienced in autism, via a comprehensive diagnostic evaluation.

## Primary sources

1. [WellSense — Applied Behavioral Analysis Prior Authorization Form, New Hampshire (updated 11/14/2025)](https://www.wellsense.org/hubfs/Forms/Provider_Forms/Applied_Behavioral_Analysis_Prior_Authorization_Form_NH.pdf)
2. [WellSense — Behavioral Health Prior Authorization/Notification Requirements, NH (effective 07/01/2026)](https://www.wellsense.org/hubfs/Provider/Prior%20Authorization/Behavioral_Health_Prior_Auth_Matrix_NH.pdf)
3. [WellSense — New Hampshire Provider Manual (effective December 1, 2025; 2026 posting)](https://www.wellsense.org/hubfs/Provider/Provider%20Manual/NH_Provider_Manual_2026.pdf)
4. [WellSense — Prior authorization (forms and portal)](https://www.wellsense.org/providers/prior-authorization)
5. [WellSense — Behavioral health (where to submit claims: Carelon vs. WellSense by date of service)](https://www.wellsense.org/providers/behavioral-health)
6. [NH DHHS — Medicaid Care Management (the three Medicaid health plans)](https://www.dhhs.nh.gov/programs-services/medicaid/medicaid-care-management)
7. [N.H. Admin. Rules He-W 500 — Medical Assistance (He-W 506, 530, 546 EPSDT, 589 Medicaid to Schools)](https://www.gencourt.state.nh.us/rules/state_agencies/he-w500.html)
8. [42 CFR 438.210(d) — Medicaid managed care authorization timeframes (eCFR)](https://www.ecfr.gov/current/title-42/chapter-IV/subchapter-C/part-438/subpart-D/section-438.210)
9. [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)

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.

Source: Carelu ABA Payer Directory — https://carelu.com/payers. Free to cite with attribution.