This notice provides an update to the April 2023 provider alert regarding which ABA providers must enroll with Apple Health (Medicaid) and which individual providers must be identified as servicing providers on ABA claims.
Providers who render services to Apple Health clients must be enrolled with the Health Care Authority (HCA) under the billing providers Core Provider Agreement (CPA) – See WAC 182-502-0005(2). Certified behavior technicians (CBTs) and Licensed Assistant Behavior Analysts (LABAs) must be enrolled with Apple Health as a servicing provider (also known as rendering or performing provider) and their National Provider Identifier (NPI) must be listed on claims for services provided.
Effective July 1, 2024, all CBTs and LABAs working with Apple Health clients must meet the following requirements:
- Have an active CBT or LABA license with the Department of Health (DOH)
- Have an NPI
- If part of a health care group or organization with a CPA, enroll with HCA as a servicing provider or non-billing provider under the group’s CPA.
- If applicable, enroll with the managed care organization (MCO) as a servicing provider.
- For dates of service on and after July 1, 2024, have their NPI captured on the claim as the servicing provider for services rendered.
Rendering and individual provider taxonomy numbers
The only applicable taxonomy number for ABA therapy services is 103K00000X. All rendering and individual providers must use this taxonomy for enrolling and billing. This includes LBAs, LABAs, and CBTs. This taxonomy code must be entered into both the billing and servicing taxonomy fields on the electronic professional claim.
Additional information:
- See WAC 182-502-0002 for eligible provider types.
- See WAC 182-531A-0800 for ABA provider requirements.
- See HCA’s Applied Behavior Analysis (ABA) Program Billing Guide.
Please contact the ABA program with any questions or comments.
For questions, please email [email protected]
